You are called to the residence of an 83 year old male with a chief complaint of shortness of breath.
On arrival you find a sick-appearing gentleman working hard to breath. He states that he woke up feeling a bit weak this morning with dyspnea-on-exertion that it has gotten progressively worse over past 12 hoursâ€”to the point where his is experiencing respiratory distress at rest. He has also had a productive cough. Noticing that he didn’t sound great on the phone his son came to visit, found him in this state, and called 911.
The patient is in moderate respiratory distress (4-5 word sentences) with a respiratory rate of 28/min and skin that is pale, warm, and diaphoretic. SpO2 is 85% on room air, improving to 92% with a non-rebreather at 15 L/min. Pulse is present at the radials but weak and his NIBP is 97/58 mmHg. Temperature is 38.3 C (oral). Lung sounds show bilateral rales and coarse rhonchi through much of both lung fields.
He denies chest pain, heaviness, tightnessâ€”or pain anywhere else for that matter.
His past medical history is significant for CAD with a prior MI, CHF, HTN, DM, dyslipidemia, and GERD.
You obtain the following ECG:
Â – How is this ECG going to affect your management? Do you need to activate the cath lab?
Â – Masters Bonus: What fairly common ECG finding is the cause of that unexpectedly tall R-wave in V2?