![]() ![]() On the other hand, with acute anterior STEMI, complete heart block and wide complex escape rhythm, permanent pacing is often required and the prognosis is much worse. ![]() With acute inferior STEMI, complete heart block, and narrow complex escape rhythm, the heart block is often self-limiting and does not require permanent pacing. With acute anterior STEMI the escape rhythm tends to have wide complexes (ventricular escape rhythm) and generally will not respond to atropine. With acute inferior STEMI the escape rhythm tends to have narrow complexes (junctional escape rhythm) and may respond to atropine. Idioventricular rhythm is a slow regular ventricular rhythm, typically with a rate of less than 50, absence of P waves, and a prolonged QRS interval. Third degree AV block occurs when P waves are not conducted to the ventricles and an ectopic, slow escape rhythm is present. Speaking of the heart rhythm, third degree AV block is a common complication of acute STEMI. We ought to know when to give medicine and when to withhold it! I would at least pause before giving nitroglycerin to any patient with a heart rate less than 40! Besides, we’re supposed to be experts in emergency care. Keep in mind that patients with chronic stable angina don’t generally call 9-1-1. Let’s take another look at the 12-lead ECG. You may want to go back and review the initial history and clinical presentation. This is the conclusion to the current ECG Challenge. Haven’t read the initial case presentation? Read: ECG Challenge: Nitroglycerin, right? Many others (both at and on Facebook) correctly identified that nitroglycerin should not be given to this patient due to the heart rate and right ventricular infarction! As always, I’d like to thank all of the readers of the EMS 12-Lead column because you always impress me with your comments!” ![]() He correctly identified the heart rhythm, fact that we’re dealing with an acute inferior-posterior STEMI, noted that ST-elevation in lead III was greater than the ST-elevation in lead II (strongly suggesting right ventricular infarction) and correctly weighed the risks and benefits of correcting the heart rate. Editor’s note: We asked columnist Tom Bouthillet to pick a winner to this month’s challenge and he wrote: “ For this month’s column I selected Troy Hoover as having the most thoughtful response. ![]()
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