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56 year old male chest pain

by on November 2, 2011

EMS call to house of 56 year old male patient who stated he was having left sided chest pain radiating to his jaw and left arm. He stated he was nauseated but has not vomited. Mild shortness of breath. Family history of heart problems and he smokes approximately one pack of cigarettes a day. He has high blood pressure and is on Lopressor. Diabetes taking insulin.

BP 130/72

Placed on monitor

12 lead obtained

From → Case File

  1. Dan Campanelli permalink

    Immediate cath patient. Anteroseptallateral MI with inferior wall ischemia, reciprocal changes in the inferior leads. I can understand the monitor thinking anterolateral, as there are elevations in V5 V6. The PVC’s are evidence of ischemia. I like to think of them as the heart saying “Help”…beat, beat, beat…”Help”. Would like to see a longer strip to see if they’re multifocal or unifocal. Either way, ASA is a must. Nitro is a possibility (use with caution – inferior wall involvement). Possibly Morphine for pain, if protocol allows (beware of potential vasodilator properties). Monitor this patient closely and transport rapidly and safely.

  2. I’d say anterior MI with evolving lateral extension as evidenced by anterior ST-E and reciprocal changes in the inferior lead group (and what appears to be the beginning of ST-E in I/aVL).

    Normocardic rhythm with a short PR, occasional PVCs. The P-waves appear to be sinus (upright I/II) but could be a right atrial focus closer to the junction. Regardless, that’s not this gentleman’s biggest problem.

    Early STEMI notification is key.

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