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Information Sheet for Candidates
You are working a night shift in the emergency department of a
rural hospital about 100
kilometers from a major city.
A 55 year old man presents at 04:0 because he woke up with
crushing chest pain and his
wife decided to dri!e him to the hospital.
What is your management?
Information Sheet for Candidates
You are working a night shift in the emergency department of a
rural hospital about 100
kilometers from a major city.A 55 year old man presents at 04:0
because he woke up with crushing chest pain and his
wife decided to dri!e him to the hospital.
What is your management?
Information Sheet for Candidates
You are working a night shift in the emergency department of a
rural hospital about 100kilometers from a major city.
A 55 year old man presents at 04:0 because he woke up with
crushing chest pain and his
wife decided to dri!e him to the hospital.
What is your management?
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Acute Inferior Myocradial Infarction
HISTORY:"he patient had a normal day and e!ening. #ent to bed at
about $:00 and was awoken at
about 0:15 by a central% hea!y and crushing chest pain behind
the breast bone whichlasted for about 0 minutes. &e felt
nauseated and sweaty all the time and his wife
decided to take him to hospital.
H!":'o significant medical or surgical (&).
*moked for about $5 years% 1 pack per day% has gi!en up just
months ago because of
increasing *+,.-rinks socially/.
#H!:other still ali!e and well. ather died at age 20 following a
stroke 3high ,(.1 older sister has angina and older brother had an
A6 at age 5$.
SH!":(at. is married with children% no problems at home. &as
been a successful accountantfor 0 years% working long hours%
recently stressed because of financial losses caused by
a partners resignation.
'o allergies
$%AMI&ATIO&:ildly o!erweight% pale and sweaty.
,( 110785% pulse rate 8$ 3*9% temp. 8 o elsius% 99 1;.
'o abnormal findings on (.
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SC$&ARIO:
The $C( changes do not normali+e, ST ele-ation does not come
do.n /
WHAT )O YO0 )O &$%T???
Frgent transfer for acute angioplasty 7 stenting
What are the contraindications for throm1olysis?
A,*+BF"
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d) Sinusrhythmwith atrial prematurebeats
e) Sinus tachycardia
wer:
The rhythm is sinus tachycardia with 3:2 AV Wenckebach (sinus
rate about 110 bpm, ventricular rate abobpm) with 3:2 conduction.
(See also Cases # 148 and 244 for comparison.)
Acute ST elevations and Q waves are present in leads, II, III,
and aVF with reciprocal ST depressions in
I, aVL and VI-V3, consistent with an acute
inferior-posterolateral infarction.
Cardiac catheterization revealed two vessel disease with a 100%
occlusion of the mid-right coronary arte
a left ventricular ejection fraction of 30%. Percutaneous
transluminal coronary angioplasty (PCTA) was
attempted without success.
Hide Answ er
Case Author(s): Diane L. Perry, CCT and Ary L. Goldberger,
MD
Copyright (c) 2001 - 2007 Beth Israel Deaconess Medical Center.
All rights reserved.
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