Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 97
IV. STEMI diagnostic tips and clinical vignettes 1. A patient presents with one episode of chest pain that lasted 10 minutes. He does not have any pain currently. He reports a prior history of a large MI 2 years previously. His ECG shows 1.5 mm ST elevation in the anterior leads with Q waves and T-wave inversion. Should he undergo emergent reperfusion?
ОглавлениеEmergent reperfusion is probably not warranted. It is important to seek old ECGs and urgently obtain an echocardiogram. In fact, ST elevation may represent an old STEMI with a chronic dyskinetic myocardium and a chronic, persistent ST elevation with Q waves; T waves may be inverted or upright, but not ample. A history of an old MI, an old ECG (if available), or a quick bedside echocardiogram may allow the diagnosis. Echocardiography shows a myocardium that is thin, not just in systole but in diastole, bright (scarred) and possibly aneurysmal in case of an old infarct, whereas in acute STEMI the myocardium is neither thin nor scarred yet. If the patient does not report a history of MI, if T wave is ample, or if he had a typical angina within the last 24 hours, ST elevation is generally considered acute STEMI.
