A 68-year-old male presents with a chief complaint of chest tightness that started at rest approximately three hours prior and has been constant ever since. He desribes it as a vice-like sensation limited to the central portion of his chest. Nothing makes the pain better or worse and he rates it at about a 6 out of 10.
At a glance the patient appears pretty healthy. He is well-nourished and of normal weight, does not smoke, and feels alright aside from the nagging discomfort in his chest. His skin in warm, pink, and dry and his radial pulse is strong, fast, and irregular.
Vitals are as follows:
- HR approx 125 bpm, irregular
- BP 110/58 mmHg
- RR 18 /min and unlabored
- SpO2 96% on room air
- Temp 37.1 C (98.8 F)
Past medical history is significant for well-controlled hypertension, DVT/PE two years prior, and incidental coronary artery disease noted on a chest CT performed for the PE.
His medications include only amlodipine for hypertension and ongoing warfarin therapy for the prior PE/DVT.
Because of the patient's chest pain and irregular pulse you perform a 12-lead ECG and see the following…
And, because it's the future, you also have immediate access to a copy of the patient's ECG from two years prior at the time of his PE/DVT…
What therapies are you going to implement to treat this patient?
Are you going to activate the cath lab?