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A 20-something presented after a huge verapamil overdose in cardiogenicshock. And she does not know that this is an overdose; she thinks it is a patient with chestpain!! Today's patient is a young male who presented in cardiogenicshock following a massive verapamil overdose. The initial K was 3.0
This was my response: If it is the right clinical situation, such as acute chest discomfort, it looks like proximal left anterior descending occlusion with right bundle branch block and left anterior fascicular block. Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenicshock.
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chestpain to Dr. McLaren. An elderly man with sudden cardiogenicshock, diffuse ST depressions, and STE in aVR Literature 1.
They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chestpain. They described the chestpain as severe, crushing, and non-radiating. Tachycardia is unusual for OMI, unless the patient is in cardiogenicshock (or getting close).
Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenicshock or impending shock. Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with ChestPain?
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