Question

A 64 year old female arrives to emergency with flu-like symptoms.

She reports that she has felt very tired for the last several days, has had severe back pain. Since waking she feels terrible (sweating, nausea, and dizziness) and is unable to keep anything down. Although coherent during the intake interview she occasionally exhibits mild confusion.

Her blood pressure is 140/80 and heart rate is 114. Her temperature is normal. Auscultation of the GI system is normal. Her EKG is exhibits depression of the ST segment and irregularities of the ST intervals.

1) What region of the heart is associated with the ST segment and interval?

2) What arteries supply this area?

3) What is your diagnosis – and why?

4) If in addition to her other symptoms the patient reported leg cramps over the last few days BUT had a normal EKG what might your diagnosis be – and why? (Hint – consider the large vessels off the heart).

Answer 1

1. Ventricles of thye heart is associated with ST segment and interval. In general, ST segment is in between the QRS complex and the T wave.

2. Coronary artery supplies this area.

3. Diagnosis: myocardial ischemia

Myocardial ischemia occurs when blood flow to your heart is reduced, preventing it from receiving enough oxygen. Due to lack of oxygen supply, the patient is facing the symptoms like sweating, nausea, and dizziness. That is why she is occasionally exhibits mild confusion (lack of oxygen supply in to the brain).