Hey Bill,
At what point were they bradycardic? The object of a stress test is to
get the HR up... was it an exercise or drug study?

Did they give you a copy of the 12leads?
Thanks
Nick

On 4/6/08, Bill Murphy NREMT-P <murphquake@gmail.com> wrote:
> Am cleaning out my "star-ed" messages and came across this case which
> is very similar to one I had about a week ago.
>
> Responded on BLS unit to a call for an unconscious at a clinic in my
> area. Led to patient by clinic staff stating patient had syncopal
> episode after becoming incresingly bradycardic (decreasingly?) during
> nuclear stress test. Staff MD in back stated patient was given 1mg
> Atropine IVP and HR normalized, currently slightly tachy with mild
> HTN. Patient adamantly refusing transport to hospital. ALS and Lt.
> arrived and after about 45 minutes of phone consultations with online
> medical direction (originally were instructed to have the patient
> signed into care of the physician on scene who had cleverly left the
> office while we were there) patient was RMA AMA. Had some fun getting
> the dosimeter to alarm on the patient repeatedly (the only thing he
> worried about). The very next day the MRI clinic next to my station
> finally replaced the awnings they had taken down a couple months
> back... with huge signs advertising stress tests and angiography. Was
> an unconscious there a week ago while I was on another call, never
> found out what but was cardiac related based on radio traffic. Have a
> feeling this is going to get old hat in the near future, but at least
> people will stop ringing our bell asking for the MRI place since they
> had no signage for so long =-D
>
> Interesting case Tom, I agree with Dave about the CHB & Inf. STEMI c
> Lat. recip. definitely time for a R sided EKG and/or 15 Lead. I know
> it's been a while but any other follow up on this?
> -bill
>
> Bill Murphy NREMT-P
> murphquake@gmail.com
>
> >From: Hildebrandt, David A <David.hildebrandt@hcmed.org>
> >Sent: Sunday, December 23, 2007 at 7:00 PM
> >Tom: I'm just looking at this super quick as I'm rushing out the
> door, but the strip looks like 3rd degree to me. EKG shows
> inferior......reciprocal in aVL and lead I. Keep in mind that 92% of
> all inferior MI's that have depression in Lead I are also RVI. So,
> should have increased suspicion for RVI until Right sided EKG done.
> Merry Christmas, Happy Holidays, Happy whatever to whatever everyone
> and anyone celebrates! Dave
>
> >>From: Station2Medic@aol.com
> >>Sent: Sunday, December 23, 2007 4:38 PM
> >>Here's another interesting case. Patient was at his physician's
> office where he had just finished a stress test. He was sitting in
> his car and started to have abdominal discomfort and belching
> associated with chest pain, nausea, and sweating. He went back into
> his physician's office where he experienced a near-syncopal episode.
> EMS was called. Vital signs: Pulse: 40 Resp: 14 BP: 97/74 SpO2:
> 96 PMH: MI 1993, stent placement Meds: Numerous cardiac meds,
> Cialis NKDA EKG: rhythm strip and 12 lead attached. What's your
> interpretation? Tom
>