Here’s a case submitted by a faithful reader who wishes to remain anonymous.
It’s a great case and destined to be one of my favorites!
EMS is called to evaluate a 80 year old male patient with a chief complaint of chest pain.
On arrival the patient is found sitting on his living room couch. He appears acutely ill and anxious.
Onset: 2 hours prior to EMS arrival
Provoke: Pain unrelieved after SL NTG x5
Quality: Severe substernal pressure
Radiate: The pain does not radiate
Time: Several previous episodes but “never this bad”
Skin is cool, pale, and diaphoretic.
Breath sounds: clear
No JVD or peripheral edema noted.
Past medical history: CABG x3, CHF, angina, renal insufficiency, LBBB
Meds: Numerous but unavailable at the time of evaluation
SpO2: 99 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
What is your impression?
*** UPDATE ***
Here are the serial 12-lead ECGs.