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Cases | Cardiothoracic | Scarlotti
What is your interpretation of Charlotte's EKG?
a. Acute pericarditis b. Acute anterior myocardial infarction c. Acute infero-lateral myocardial infarction d. Left bundle branch block
The correct answer is c., acute infero-lateral wall myocardial infarction. The marked ST elevation merging into the T waves in leads 2, 3, F, and V5-6 are characteristic of acute infero-lateral wall myocardial infarction. Within minutes to hours the T waves will invert and the ST segments will begin to return to baseline. The marked ST depressions in leads 1, L, and V1-3 are known as reciprocal changes and do not represent damage to the anterior wall. What is the mechanism of reciprocal ST depression in myocardial infarction?
Which of the following would not be expected to be of benefit to Charlotte if given within the next 6-12 hours?
a. Aspirin b. Beta blocker c. Tissue plasminogen activator (TPA) d. Calcium channel blocker
The correct answer is d. Calcium channel blockers should be avoided in patients with acute MI except in the treatment of arrhythmias or ongoing chest pain in patients who are unable to take beta blockers (for example, because of asthma or medication allergy). All of the other agents have been shown in well designed studies to reduce mortality when given to acute transmural MI patients within hours after the onset of chest pain.
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