911 responded to a 63 year old male with chest pain. On arrival, the first EKG did not show any ST elevation, and was read as a "normal EKG."
The paramedic reported that 5 minutes later shows the patient having his STEMI. As you can see, he starts to develop a right bundle branch block and completes this is his last EKG.
There is a lot of artifact on that last EKG as the patient was so diaphoretic that the patches would barely stay on.
The patient was taken directly to the cath lab where he was found to have a 99% stenosis of his LAD, his culprit lesion. He ultimately did well although he initially did have a depressed ejection fraction on his echo done post cardiac catheterization.
LAD lesions, (also known as the "Widowmaker") present with ST elevation in V1, V2, V3, and V4 and are often times accompanied by new right bundle branch blocks. You will often see high grade AV blocks as well.
EKG's are just a snapshot in time, and a lot of times can change in minutes. If you are worried about a patient, sometimes it is easier to leave the EKG patches on and continue repeating serial EKG's.
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