Here’s a great case submitted by a faithful reader who wishes to remain anonymous.
EMS is called to a 26 year old male complaining of chest pain.
On arrival patient is found sitting on his living room couch. He appears anxious and acutely ill.
He states that he was riding his bike when he became anxious, had a “coughing spell” and started to experience chest discomfort.
The location of the chest discomfort is in the center of his chest and slightly to the left.
Onset: Sudden while riding a bike
Provoke: Nothing makes the pain better or worse
Quality: Difficult to describe but with prompting the patient calls it “pressure”
Radiate: Left jaw and left arm
Time: No previous episodes
The patients skin is warm and moist. The color is normal.
The patient denies shortness of breath. Breath sounds are clear bilaterally.
He is nauseated but he has not vomited.
Past medical history: Healthy
Vital signs are assessed.
SpO2: 100 with oxygen via NRB @ 15 LPM
The cardiac monitor is attached.
A 12-lead ECG is captured.
What is your impression?
*** UPDATE ***
The importance of serial ECGs cannot be over-emphasized.
In this case, a second 12-lead ECG was captured just prior to arrival at the hospital.
Does this new information shed any light on the probably diagnosis?
What else could you have done?
ANSWER: Apply posterior chest leads V7, V8, and V9
Just for fun, here’s what the follow-up ECG looks like “flipped” over and held up to a light.
Do you see the STEMI now?
Anterior ischemia or posterior STEMI? (at Paramedicine 101)
74 year old male CC: Chest pain – Final update (angiograms)