So, new medic here just trying to pick at someone else’s brain. Just wondering if anyone else has run into this before, I’m learning and curious.
Recently had a call for a late 20’s to early 30ish year old patient, dispatch advised a brief syncopal episode after acupuncture. Get there and the patient is extremely pale and diaphoretic - like dripping off the table like a waterfall diaphoretic - and notably just restless and uncomfortable. Patient denies any chest pain or shortness of breath, just repeats that they just don’t feel right. Heart rate, blood pressure, SPO2, BGL, etc…all within normal limits. No medical history, not taking any medications. Was completely fine before this sudden onset of symptoms.
Get a 12 lead almost immediately. While it’s printing, my partner - also a medic and more experienced than me- gets this look on their face and, before I’m even handed the 12 lead, I already have an idea of what to expect. (I know it’s horrible not to have a picture of the actual 12 lead but you’ll just have to take my word for it) there’s 1mm of elevation in leads II, III, and aVF. Depression in aVL, V1, and V2. Then over 10mm of elevation in V3 and 4mm of elevation in V4. Send 12 lead over to the hospital during transport and they’re like cool, the cardiologist is going to be breathing down your back doors when you get here. Transport is smooth, no issues - all appropriate treatments/interventions done. But a few repeat 12 leads show that the elevation in the inferior leads are disappearing over time, but stays consistent in V3 and V4 for both me and the hospital. At the hospital, the cardiologist goes through all the 12 leads with me and he’s also pretty confused (12 lead changed again on their monitor and he goes “none of the reciprocal changes make any sense” and “why does the sloping look so off”), he decides to call it and do a cath for exploratory purposes regardless of the troponin levels. Next day, get an update that the cath didn’t reveal anything besides 25% narrowing of the LAD and cardiologist is considering a coronary artery vasospasm but he basically goes, I don’t actually know (valid, medicine be like that sometimes). The patient got a long stay for observation and I don’t know if anything came from it. So I’m wondering if anyone else has experience with a coronary artery vasospasm or any other weird ST elevation things that you just couldn’t make sense of. (I know I’m not a doctor or cardiologist, not my job to know/diagnose, I’m simply just curious)