Here’s a case from a faithful reader who wishes to remain anonymous.
In his own words:
Presenting Complaint – Chest Pain
History of Present Complaint – 69 year old male, nil cardiac history, none smoker, social drinker.
Complaining of indigestion last 2-3 weeks with noticably increase in belching.
This a.m acute onset of burning heavy central chest pain radiating to neck.
On Arrival – Semi-recumbent in bed
Alert, orientated and communicable (GCS 15)
Nil SOB, clear bi-lateral air entry – nil adventitious breath sounds
R/R 16, SpO2 98%
H/R 90 and irregular, Hypertensive 168/110
Temp 36.5 C (97.7 F)
C/O chest pain..
O – Acute
P – Nothing makes pain better. Not affected by breathing
Q – Heavy in chest, burning in throat
R – Retrosternal and radiating to neck
S – Pain score 10/10
T – 15 mins
I – No pain intervention sought.
Nil nausea, nil vomit
The cardiac monitor is attached.
A 12-lead ECG is captured.
What is your impression?
*** UPDATE ***
The patient lost consciousness and the monitor showed ventricular fibrillation. A shock was delivered at 200J.
The patient experienced return of spontaneous circulation.
A few minutes later the heart rhythm returned to baseline.
Emergent cath revealed 100% occlusion of the LAD.