Secondary Logo

Journal Logo

Spontaneous Circulation: Secrets Behind the Curtain

Bruen, Charles MD

doi: 10.1097/01.EEM.0000453998.30249.0c
Spontaneous Circulation

Dr. Bruenis a fellow in critical care medicine and emergency cardiology at Hennepin County Medical Center in Minneapolis. He has special interest in stabilization, resuscitation, hemodynamic evaluation, and emergency cardiovascular care. Visit his website,http://resusreview.com, follow him @resusreview, and read his past columns athttp://bit.ly/SponCirc.

Figure 2

Figure 2

Figure

Figure

EMS had been called to the house of a 54-year-old man. He had been experiencing chest pain on and off for several weeks. The most recent episode began about 30 minutes prior to his ED arrival. He described 8/10 retrosternal pressure that radiated down his arms. He was tachypneic, but denied shortness of breath and was not hypoxic. Other vital signs were normal.

He was slightly nauseated, but had not vomited and was not diaphoretic. Paramedics had treated the patient with sublingual nitroglycerin and aspirin, and obtained an ECG en route to the hospital. (Figure 1.)

Figure 1

Figure 1

The ECG shows sinus rhythm with a rate about 60 bpm. There is diffuse ST-segment elevation in V2-V5, II, III, and aVF, with reciprocal depression in aVL. Maximal ST-elevation is 3-4 mm in lead V3. As part of the effort to reduce door-to-balloon time, our paramedics can activate the cardiac catheterization lab based on the clinical history and a 12-lead ECG obtained in the field that indicates STEMI.

He was found to have a 100% occlusion in the mid-LAD that was reduced to 0% with a thrombectomy and placement of a drug-eluting stent. (Figure 2.) A co-culprit lesion was identified in the mid-RCA with 100% occlusion that was reduced to 0% with stenting.

Find a complete discussion of this case with additional images and videos on Sept. 4 in the EMN iPad app and on Sept. 10 in the Spontaneous Circulation blog on www.EM-News.com, where the EMN app can be downloaded for free.

Access the linksin EMN by reading this on our website or in our free iPad app, both available atwww.EM-News.com. Comments?Write to us atemn@lww.com.

© 2014 by Lippincott Williams & Wilkins