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Check me out Please!

by on July 15, 2011

EMS arrived on scene to find a 53 year old female patient complaining of chest pain. She stated heaviness in her chest that does not seem to go away and is causing her to have some mild shortness of breath. She denies any N/V and when asked about medical history she stated High Bloop Pressure with medication of Lopressor. She stated she has never had any issues like she is experiencing. She is a 2 pack a day smoker. Pain/pressure is 7/10 and nothing makes her condition better or worse. She stated she just called EMS to take her vital signs and does not wish to go to the hospital. Just “Check me out please.”

BP 160/60
RR 16
HR 106

No other medical history
No other medication
No other Info available

I apologize in advance for the poor EKG quality

Her 12 lead

What do we do?

Here is the Conclusion

From → Case File, Education

  1. VinceD permalink

    Sinus tach ~115 bpm, normal PRi, normal QRSi, normal axis ~0 degrees as best I can tell.

    Now the interesting parts:
    Poor R-wave progression across the precordials.
    Complete T-wave inversions in I and aVL with a terminal inversion in V2 (and maybe a hint in V3, I can’t tell).
    Straightening of the initial t-wave in I and aVL.
    ST-elevation in V2, perhaps also in V1.
    I’m having trouble deciding where there is ST-depression, but there may be some in II and V4-V6.
    Tall T-waves in III and aVF, likely hyperacute.
    Non-specific t-wave flattening V4-V6.
    I’m not going to try and measure the QTi, but it appears on the wide side of normal, consistent with a pathological cause of her t-wave changes.

    My overall impression is that the ECG is consistent with Wellens’ Syndrome, however her continued pain is a bit unusual as classical Wellens’ exhibits these features during a pain free state. That doesn’t affect my care, however, as she will most definitely be going to the hospital. The tracing doesn’t meet our regional criteria for a STEMI-alert, however I would be calling ahead to alert med control that there is a patient en route with chest pain and the above ECG changes, so they can mobilize as they wish. She’ll get aspirin, nitro, and oxygen while we travel, along with serial ECG’s. I may also break out the metoprolol in this case, even though I rarely push to give it to ACS in the field.

  2. I’m with Vince, tough to say STEMI, but those right precordials sure do look like ACS. Trend the 12-Leads and call if there are bad changes.

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