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78 year old male with chest pain

by on December 4, 2011

EMS called to house of 78 year old male who stated he began to have acute onset of chest pain left side of chest 6/10 feels like a squeezing sensation.  He tells EMS that he has shortness of breath and nothing seems to make his pain better or worse.  He is fully alert and oriented.  At time of onset he was eating lunch.  His medical history is diabetes and high blood pressure,  He also has angina,  Medication of Insulin, Metoprolol, Crestor, Aspirin and Insulin.  He does have a cardiologist but has not been in for a check up in just over a year.

Blood Pressure  130/80

skin w/d

Lungs clear = bilateral

12 lead obtained



From → Case File

  1. Anonymous permalink

    st decreased…???

  2. LBBB with excessively discordant STDepression, and exc discordant STE in aVR. Ischemia, but not STEMI.

  3. Andrew Okey permalink

    Elevation in AVR, LBBB, Would do a posterior V7-9 and RV-4, to see what they showed. Treat the Pt.

  4. Anonymous permalink

    normal sinus rhythm with wide QSR complex and t wave invertion in the inferioand lateral lead
    the diagnosis is LBBB with inferior ishemia

  5. Anonymous permalink

    Clear ST-Depression with a LBBB. Probably ischeamic as a result of the LBBB

  6. Eff Dogg permalink

    Can someone please clarify- Discordant ST elevation can be attributed to a LBBB but concordant indicates MI. correct? Thanks. F

    • @eff dog
      That is correct. A LBBB should have discordant qrs/t. Concordant st segments is a qualifier for LBBB stemi. Also concordant st depression in early V leads are also a qualifier as explained in Sgarbossa’s criteria

  7. Anonymous permalink

    ST deviation is all discordant, only V4 may not be very clear, so depent on this ekg, I can’t say ischaemie.

  8. Anonymous permalink

    LBBB. probably AMI, but difficult to diagnose on 12 lead due to LBBB. If no contra-indications: Aspirin, GTN, ? oxygen, Metoclopramide and Morphine Sulphate.

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