It’s a sunny winter afternoon when you and your partner are called to a local doctor’s office for an “adult male- possible heart”.
When you arrive, you are led into room #3 where you find a 74 year old male, in no apparent distress. His color looks good.
You introduce yourself, and find out that your patient was suffering from left sided chest discomfort, 4/10, that radiated to his right arm.
“I can’t believe I have to go to the hospital, I thought it was something minor”, he tells you.
He admits that he has had short episodes like this for the last couple of days, but that today’s is worse. It doesn’t seem connected to exertion, and nothing makes it better. He can’t quite localize the discomfort, and it doesn’t change with breathing.
He denies any shortness of breath, diaphoresis, lightheadedness or nausea/vomiting.
His past medical history is significant for: Prostate cancer, high cholesterol, peptic ulcer disease and chronic back pain.
Vitals are as follows:
- HR: 84 and regular
- BP: 152/84
- RR: 18 and regular; SpO2 98% on supplemental O2
- Skin: warm and dry
You acquire the following 12 lead ECG:
You package the patient and acquire a second 12 lead ECG:
Decision time: Community hospital is 20 minutes away by ground. PCI center is about 30 minutes away by helicopter. As you ponder your decisions, he tells you again that he “still can’t believe he has to go to the hospital !”
What is your interpretation of the 12 lead ECG’s?
What do you want to do with your patient? What are your transport and treatment decisions?
Are there any significant changes between the first and second ECG?