A 75-year-old woman presented to the AED with SOB and mild chest pain of unknown onset. Her BP was 160/90 mmHg, and SpO2 was 94% on 2 L/min O2 via nasal cannula (NC). She has a known history of ischemic heart disease, with a recent follow-up in mainland China.
What is the most appropriate next step in management?
Choose the correct answer.
The ECG showed Q waves and ST elevation in leads V1–V5, which could be attributed to either an acute or an old anterior STEMI.In the presence of Q waves and a history of ischemic heart disease, it is preferable to obtain a prior ECG for comparison to determine if the ST elevation is chronic.
An echocardiogram can provide further evidence to differentiate between acute and chronic myocardial infarction, as wall thinning is typically present in prior infarctions, whereas preserved thickness is suggestive of a more recent onset. Therefore, the most appropriate next step is an echocardiogram.
