Delayed Cath-Lab Activation for STEMI Due to Erroneous Computer Electrocardiogram Interpretation: A Note of Caution for Emergency Physicians
| Autor: | Engy Helal, Enrico M. Camporesi, Hesham R Omar, Devan, Mangar |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test Cath lab business.industry medicine.medical_treatment Physical examination Chest pain medicine.disease Drug-eluting stent Internal medicine Emergency medicine medicine Left atrial enlargement Cardiology Sinus rhythm cardiovascular diseases Myocardial infarction medicine.symptom business TIMI |
| Zdroj: | Emergency Medicine: Open Access. |
| ISSN: | 2165-7548 |
| Popis: | A 67-year-old gentleman experienced retrosternal burning pain radiating to both elbows associated with shortness of breath and sweating while he was hunting. The pain was initially intermittent but later became constant that prompted him to come to the emergency room (ER) for evaluation. He had no prior history of chest pain or cardiac disease. He has a medical history of gastro-esophageal reflux disease with different symptoms from the current presentation. He never smoked, does not drink alcohol or use illicit drugs and has no family history of premature coronary artery disease. His physical examination in the ER was unremarkable and he was vitally stable. His electrocardiogram (ECG) was read by the computer as sinus rhythm, possible left atrial enlargement and STsegment depression (STD), consider subendocardial injury (Figure 1). There was a 1 mm STsegment elevation (STE) in leads I, avL with reciprocal STD in leads II, III, aVF suggestive of high lateral ST-segment elevation myocardial infarction (STEMI). This was not recorded by the computer ECG which has delayed cath-lab activation 45 minutes from onset of initial ECG. After evaluating the ECG by an astute emergency physician, the cardiologist was contacted for a working diagnosis of high lateral STEMI and the cath-lab was activated. Coronary angiography revealed total occlusion of the 1st diagonal branch and 99% occlusion of midLAD which prompted drug eluting stent deployment in both vessels followed by TIMI III flow. Peak troponin I value was 50 mg/mL (normal 0.02-0.03 mg/mL). Repeat ECG 12 hours later showed the development of pathological Q waves in leads I and aVL. Myocardial perfusion scan showed scar in the affected territory. He had no recurrence of chest Delayed Cath-Lab Activation for STEMI Due to Erroneous Computer Electrocardiogram Interpretation: A Note of Caution for Emergency Physicians |
| Databáze: | OpenAIRE |
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