I have been following the thread with keen interest. First of all I
seriously doubt this is "food bolus obstruction" especially when you note
that there is no real temporal relationship. It occurred 4 hours after the
donut ingestion! If anything it is a red herring!
Jeff and Jim: I am not convinced this is an acute coronary syndrome. DMD is
associated with dilated cardiomyopathy. He is 12 years old. I see no reason
for him to be at risk for CAD. This may be "bad" muscle but the "piping"
should be fine. Given this, I am not sure about thrombolytics,
catheterization etc. Also, why would he be at risk for dissection or
vasculitis?? Obtaining right sided and posterior leads makes sense to me. It
is easy to obtain and would clarify the diffuse ST changes further.
I wholeheartedly agree with Jeff Mann's other line of thinking w.r.t such
diffuse ST-T changes. The changes described affect his antero-septal,
inferior & lateral wall. He does need an emergent echo-cardiogram to rule
out pericarditis. Besides, if he has evidence of cardio-myopathy he is also
at risk for development of ventricular aneurysm that could give such diffuse
If his echo is normal, given his symptoms of anxiety and chest pain, ST_T
changes and an "immobile" state, I am very concerned about PTE. I would
pursue that aggressively with an ABG, VQ scan etc..............
Hugo, could you give us follow up on his case. What did his echo
demonstrate? It would be nice if you could post his EKG on the list.
Jay Pershad, MD
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