CMC Case Conference - Dr. Beverly

Abnormal Presentations of ACS
-Always think of this on your differential
-Frequently re-evaluate patients
-Interpret ECGs in a systematic fashion - and do this every time!

RBBB and STEMI
- No criteria for STEMI as there are in LBBB
- Any ST elevation is abnormal 
- Read your EKG’s carefully and compare to old
- It is never a bad idea to get serial EKG’s if the presentation is unclear ("One ECG Begets Another")

De Winter’s Sign
- This is an Anterior STEMI Equivalent!
- Seen in 2% of acute LAD occlusions
- Criteria
     -Tall prominent symmetric T waves in the precordial leads
     -Upsloping ST segment depression > 1mm at the J point
     -No ST elevation in the precordial leads
     -ST elevation in aVR

aVR Sign
-Widespread horizontal ST depression, most prominent in I, II, V4-V6
-ST elevation in aVR >1mm
-ST elevation in aVR >V1

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Hyphen
- Defined as blood in the anterior chamber
- Complete a full visual examination
- Must evaluate for ruptured globe 
- Ruptured Globe = Tetanus, antibiotics and emergency consultation

Siedel’s Sign
- Evaluates for aqueous humor leak secondary to violation of the anterior chamber
- Apply topical anesthesia
- Paint eye with fluorescein dye
- Test is positive if there is a stream of dye emanating from the wound site