A 74 year old woman with previous hypertension and type II diabetes presents with epigastric pain and distended abdomen. She is breathless.
Her observations are as follows:
SaO2 85% on room air, NIBP 90/55mmHg, Respiratory Rate 24/min and Temperature of 37.5oC.
a. Describe and interpret her ECG (50%) b. List the treatment for this woman (50%)
FACEM VAQ Exam 2004.1 – Question 1
- The overall pass rate for this question was 59 / 69 (85.5%).
- An ECG demonstrating extensive ST elevation AMI is shown.
- Examiners expected that the ECG would be correctly interpreted as showing an inferoposterolateral infarct with the possibility of right ventricular involvement.
- It was expected that the ECG would be interpreted in light of the presented scenario with a number of pressing clinical issues such as hypoxia, cardiogenic shock and the potential for an abdominal cause or complication such as ischaemic gut.
- The treatment needed then to address all of these issues and was not just that of a simple infarct.
- The commonest cause for failure was the lack of appreciation of the presence of shock and the urgent need for its treatment. Some candidates were not able to appreciate the extent of the infarct shown on the ECG.