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46 yo male patient sudden onset of Chest Pain

by on March 26, 2011

46 year old male with history of Coronary issues called EMS stating he was working cutting his lawn on his mower when he began to have some chest discomfort. He stated pain was left side of chest and now seems to be moving into his left arm. He appears to be anxious and pale. Skin is cool but dry. Lungs are clear and equal with SP02 of 95%, he does state some dyspnea. He does not complain of Nausea or Vomiting.

Blood Pressure: 130/90
Respirations: 16
QTc: 420ms
A 12 lead is obtained: Press CTRL and + to enlarge ekg

What do you think and how do you wanna treat?

From → Case File

  1. Deborah permalink

    Well it is hard to see on this monitor, even with it zoomed in, but it looks like an anterior STEMI. High flow 02 and after asking about ED drug usage, 324mg ASA w/ 0.4mg nitro q 5 min, large bore IV of NS in the AC and rapid transport to a cath lab. If the nitro doesn’t help the pain and BP stays good I’d call for morphine. If there is time I’d do a 15-lead as well.

    • Deborah, Thanks for posting and welcome, I would agree with your assessment and your treatment. Poor R wave progression in the early V leads and ST elevations in Anterior leads along with reciprocal changes are strongly suggestive of an Anterior STEMI. Probably LAD artery occlusion as the culprit.

  2. T-waves appear hyperacute in the precordium…

    Thank you for the interesting EKG and excellent bloging!

  3. Tough to see, but clearly hyperacute anterior T-waves, which when compared to other lead groups appear to stand on their own (not suspicious for Hyper-K). Inferior ST-depression, likely reciprocal to the anterior changes. I can’t tell if there is a small r or if those are QS complexes in V1-V3, but regardless I’m sold on anterior STEMI (or at least progressing to become one shortly).

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