Test Your STEMI Skills

QUESTIONS:

1. STEMI?

2. Territory?

3. What is the Culprit Vessel?

1. ECG Interpretation (STEMI)?

a)  Acute STEMI

b)  LVH

c)  LBBB

d)  Ventricular Pacing

e)  RBBB

f)   WPW (w pre-excitation)

h)  Acute Pericarditis

i)   Early Repolarization

j)   Hyperkalemia

k)  “Hakuna matata”

 

2. STEMI Territory (mark all that apply)?

a)  Inferior

b)  Lateral

c)  Posterior

d)  Right Ventricle

e)   Anterior

f)   Septal

g)  Don’t know

h)  Does not apply

 

3. What is the Culprit Vessel?

a)  Proximal LAD

b)  Distal LAD

c)  Diagonal or Obtuse marginal branch

d)  Circumflex artery with PDA 

e)  Proximal RCA
f)   Distal RCA

g)   PDA

h)  Does not apply

i)  “God knows”

 

LAD= left anterior descending artery

RCA= right coronary artery

PDA= posterior descending artery

 

Case #1:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #2:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

87 y/o male with one hour evolution of shortness of breath. He was brought by relatives to the ED.  He presented with respiratory distress and severe hypotension. 

Case #3:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #4:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

84 y/o male with hx of HTN, DM, CKD and past CVA. He was brought by relative in view of complaints of dizzy spells, nausea, fatigue, weakness and chest tightness since waking up in the morning about 6 hour ago. The patient arrived hypoactive, slow mentation and hypotensive with the below ECG.

Case #5:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

87 y/o male with history of HTN, DM, dementia, PTSD, OSA, CAD, past CABG and CHF. He presented to ER with complaints of progressive SOB in the last 3 days. Now presenting with on and off chest pain of 2 hours of evolution. He arrived without chest pain, severe HTN, and clinical findings of pulmonary edema. 
 

Case #6:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

70 y/o female with history of chronic HTN, aortic valve insufficiency and CHF. She presents with worsening of SOB since the night prior to presentation and chest tightness since about 1 hour of evolution. She was found with BP at 220/110 mmHg. 

Case #7:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #8:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #9:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #10:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #11:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #12:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #13:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #14:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #15:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

82 y/o male with hx of HTN, CAD, old MI and past CABG X3 1998. Presenting with

a severe retrosternal oppressive CP of 5 hours of evolution. Treated with nitrates in

ER, but persists w CP. Labs: Cardiac enzymes: Trop=I=2.6, Trop-T=0.39, CK-MB=53

Case #16:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

71 y/o male that is s/p open heart surgery with CABG x3, day #2 with chest pain complaints related to sternotomy area and with trop-T at 1.2 ng/ml and CPK-MB at 35 ng/ml.

Case #17:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #18:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

63 y/o female with history of HTN, hyperlipidemia, DM-2 and BA. Presenting to a Local Health Center with nausea, diaphoresis and chest tightness of 2 hours of evolution. She denies chest pain. Initial cardiac markers are negative for AMI. BP 100/55 mmHg. Lungs CTA. No JVD and normal heart sounds.

Diagnosis?

Case #19:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

45 y/o male with history of HTN, DM-2, chronic smoker, with history of cocaine and cannabis use. He is a bartender and was walking home after his overnight shift, when he developed a sustained chest pain of 2 hours of evolution, with associated diaphoresis, nausea and SOB. He used cocaine 1/2 hour prior to CP starting. ECG upon ER arrival:

Case #20:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

67 y/o male patient with ongoing oppressive non-radiating chest pain of 10/10 intensity, of four hours duration, that was associated to SOB and dizziness. Upon paramedic evaluation he was found at home with hypotension at 60/40mmhg and oxygen saturation at 88%. He was placed on IV fluids and Trendelenburg position with some improvement. Upon ER arrival he was still with severe chest pain and hypotensive. His arrival  ECG was the following:

Case #21:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #22:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

45 y/o male with history of HTN, DM-2 and  family history of premature CAD.
He was brought to ER in view of a persistent sternal chest pain of 2 hour evolution that started leaving the gym after weight lifting.

Case #23:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #24:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #25:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #26:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #27:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Título secundario

Case #28:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #29:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #30:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Does this Patient Benefit from Emergency Reperfussion?

Case #31:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Does this Patient Benefit from Emergency Reperfussion?

Case #32:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Does this Patient Benefit from Emergency Reperfussion?

Case #33-A:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #33-B:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #33-C:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #33-D:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #34:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #35:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #36A:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

Case #36C:  STEMI? Wall territory? Culprit coronary artery? Verify your response in the answer button.

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