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EMS personnel found him seated on a bench, uncomfortable, but without gross distress. MICU transport was unremarkable. A third, and final, EMS 12 Lead ECG was recorded: The precordial ST segments (even Leads I/aVL, as well) have reverted to a dramatically depressed state. it has been subsequently deemed a STEMI-equivalent.
The Case An 88-year-old woman with a history of dementia, major depressive disorder, and hyperlipidemia presented to the ED via EMS after a near syncopal episode. EKG is concerning for acute STEMI with STE in lead I and aVL with reciprocal changes. The patient is also hypotensive and hypoxic, concerning for cardiogenic shock.
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