STEMI StoriesPeter O’Brien, MD, FACC

Virginia Heart Attack Coalition/Mission Lifeline

Case #1

• 62 yo male with a h/o tobacco use, Etoh, who presented with CP. Patient had been consuming etoh most of the day, so history was difficult to obtain. CP had started sometime earlier that day. Called EMS (Charlotte County). No meds. On exam, BP 85/60, HR 30’s. After atropine 70’s. Alert, but mild distress. Exam otherwise normal except to systolic murmur 1/6. Lungs were clear.

• Charlotte Co. performed 12 lead, but didn’t have equipment to transmit.

• Made the diagnosis, and called Centra One air transport. They were met in the parking lot of Southside hospital in Farmville and transported to LGH.

• Stopped in ED for assessment given mental status and hemodynamics. Transported to Cath Lab.

• Post procedure transferred to CCU. Did very well with no post-procedural complications. Echo: EF 60% with no wall motion abnormalities. Peak CK 1800, TnI 21. Discharged hospital Day 2.

Case #2

• 32 yo male with no prior PMH, who presented with CP, diaphoresis and nausea. Similar episode 2 month prior for which he didn’t seek medical attention. Takes no medications. No tobacco or other illicit substance.

• Called EMS and PHECG was obtained.

• Decision was made to bypass ED and patient was taken directly to the cath lab

Hospital Course

• Did well post-procedure. Peak CK 188/MB 15. Troponin 2.54.

• Discharged home hospital day #3