ECG Case: 67-year-old Diabetic Man with Low Blood Pressure

00:01 Well, let's do a couple of cases just to give you an example of acute MIs with a story and with the ECG.

00:09 A 67-year-old diabetic man with a history of elevated blood cholesterol and hypertension comes to the hospital complaining of feelings of indigestion in his upper abdomen and lower chest.

00:20 He's sweating, he has a low blood pressure--96/60 mmHg, and his heart rate is 52 beats per minute.

00:27 What's important here: diabetic--higher risk for atherosclerosis, elevated cholesterol and hypertension- higher risk for atherosclerosis and heart disease, he has discomfort in his upper abdomen and lower chest--could be a myocardial infarct, and then of course he's a little bit hypotensive and he's bradycardic.

00:50 Okay. Here's his ECG. Look at it for a few moments and see if you see anything abnormal.

01:04 So, there's ST elevation in leads 2, 3, and aVF and reciprocal changes in 1 and aVL.

01:11 And this is an acute inferior myocardial infarction.

01:17 By the way, it's not uncommon for acute inferior myocardial infarcts to depress the blood pressure a bit and the heart rate usually because vagal activation that's involved in inferior MIs.

01:29 So, the slow heart rate and the low blood pressure are very commonly seen in inferior MIs and usually they get better as the MI gets better.

01:37 What's interesting is if the patient goes to the cath lab and you open up usually the right coronary artery, the low blood pressure and the low heart rate disappear immediately.

01:46 So, what's the -- we give them evidence-based medications.

01:51 Angioplasty is performed on occluded right coronary artery, does well and goes home in two days with an appointment to follow up with his cardiologist.