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6. A 77-year-old female with a history of dyslipidemia, hyperthyroidism, and colon cancer presents to the emergency room with chest pain that radiates to her left arm. She has a blood pressure of 70/43, is diaphoretic, and is extremely nauseous. Her symptoms occurred after she left a nearby casino, where she had spent several hours. You attend to her in the emergency room and order a 12-lead EKG, stat. a. You are suspicious of a posterior myocardial infarction. What kind of 12-lead EKG would best capture the ST changes of a posterior MI and how is this type of EKG performed? i. Right-sided EKG and move left-sided anterior leads V4, V5, and V6, to the posterior left chest in a V7, V8, V9 configuration, also change setting on EKG machine to “right sided EKG.” ii. There is no such technique available, you simply have to infer that depression in atypical leads and multiple leads could indeed be indicative of a posterior MI. iii. Place all leads on the posterior left torso, thus mirroring the usual placement on anterior torso. iv. Obtain serial troponins and recheck the EKG in 4 hours.
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