Here's a new snapshot case straight from the UK… We have a 32 year old male, normally fit with no history whatsoever. He has had a stressful week (personal issues), and decided maybe a 4 mile run might help. It didn't. When he returned home, he developed sudden onset of chest discomfort, and decided to lie down for bit. After a couple of hours, he wasn't feeling better and called 911.
While he is alert and oriented, he is also anxious and diaphoretic. Lungs are clear bilaterally, but the RR is elevated at about 30. Pulse is too fast to count, but the BP is 126/70. He describes the chest discomfort this way: "I feel like someone is punching me in the chest!" It is substernal, non-radiating, and rated a 5/10. His only other complaint is a touch of lightheadedness.
Here is the rhythm strip and 12 lead:
Your mission, should you choose to accept it, involves coming up with a differential diagnosis for our patient, and stating which factors favor one diagnosis over another. Oh, just one more thing… How do we treat him?
We look forward to your excellent responses!