216. Chest Pain and Hypotension in an Adult Male Patient

  1. Christopher P. Holstege MD1,2,3,
  2. Alexander B. Baer MD1,4,
  3. Jesse M. Pines MD, MBA, MSCE5,6 and
  4. William J. Brady MD7,8,9

Published Online: 3 AUG 2011

DOI: 10.1002/9781444397994.ch216

Visual Diagnosis in Emergency and Critical Care Medicine, Second Edition

Visual Diagnosis in Emergency and Critical Care Medicine, Second Edition

How to Cite

Holstege, C. P., Baer, A. B., Pines, J. M. and Brady, W. J. (eds) (2011) Chest Pain and Hypotension in an Adult Male Patient, in Visual Diagnosis in Emergency and Critical Care Medicine, Second Edition, Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444397994.ch216

Editor Information

  1. 1

    Division of Medical Toxicology, University of Virginia School of Medicine, Charlottesville, VA, USA

  2. 2

    Blue Ridge Poison Center, University of Virginia School of Medicine, Charlottesville, VA, USA

  3. 3

    Departments of Emergency Medicine & Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA

  4. 4

    Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA

  5. 5

    Center for Health Care Quality, George Washington University, Washington, DC, USA

  6. 6

    Departments of Emergency Medicine and Health Policy, George Washington University, Washington, DC, USA

  7. 7

    Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA

  8. 8

    Center for Emergency Management, University of Virginia Health System, Charlottesville, VA, USA

  9. 9

    Charlottesville-Albemarle Rescue Squad & Albemarle County, Fire Rescue, Charlottesville, VA, USA

Publication History

  1. Published Online: 3 AUG 2011
  2. Published Print: 12 AUG 2011

ISBN Information

Print ISBN: 9781444333473

Online ISBN: 9781444397994

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Keywords:

  • Case 106, chest pain - and hypotension in adult male patient;
  • diagnosis - inferoposterior right ventricular acute myocardial infarction;
  • ST segment depression, in leads V1–V3 - consistent with posterior wall acute myocardial infarction (AMI), or anterior wall ischemia;
  • ST segment depression with T wave inversion - in leads I and aVl, and reciprocal change;
  • posterior wall myocardial infarction - to AMI of posterior wall of left ventricle;
  • posterior ECG leads - in evaluation of posterior wall;
  • sensitivity of posterior ECG leads - as high as 90%, for identifying posterior AMI;
  • right ventricular myocardial infarction - hypotension, elevated jugular venous pressure and clear lung fields;
  • addition of lead RV4, evidence - of right ventricular involvement, more so than that noted on 12-lead ECG;
  • RV infarction, diagnosed with 80–100% sensitivity - by ST segment elevation, greater than 1 mm in lead RV4