EKG of the Week – Week 32 ANSWERS

For the first ekgs: STEMI or NO STEMI: STEMI.  This is an inferior wall MI, you can see ST elevation in II, III and aVF     

The second EKG is a little more interesting.  Why would a 22 yo F who gave birth 7 days ago have an EKG that looks like this?  This is concerning for something called SCAD or spontaneous coronary artery dissection.  What is SCAD?

     SCAD is a non-atherosclerotic, non-traumatic cause of coronary artery dissection.  it is the MOST COMMON identifiable cause of MI in pregnancy or the postpartum period.  25% of acute MIs in pregnancy are due to SCAD, where as in nonpregnant women it is responsible for <1%.  If you have an otherwise healthy person who presents like a 50s yo smoking, hypertensive, diabetic with crushing substernal chest pain and diaphoresis, think about SCAD.

How do you diagnose it?  It gets diagnosed in the Cath lab by the interventionalist.  

EM docs does an excellent write up on SCAD:  http://www.emdocs.net/spontaneous-coronary-artery-dissection/