By request I'm trying something new. The 12-lead ECG will be cropped and the computerized interpretation removed until the solution is posted. Let me know if you find this approach to be useful. This is how I used to teach 12-lead ECG interpretation but I started leaving the computerized interpretation because that's reality — you'll have access to it in the field (unless you're one of those few systems that turns the comptuerized interpretation off).
EMS is called to the residence of a 63 year old male with a chief complaint of shortness of breath.
On arrival the patient is found sitting on the edge of his bed. He appears to be in moderate respiratory distress.
Past medical history: HTN, IDDM, CHF
Medications: Numerouos (the spouse hands you a large plastic container full of medications)
On questioning the patient admits that he is also experiencing chest tightness.
- Onset: 30 minutes prior to EMS arrival
- Provoke: Symptoms are worse lying flat
- Quality: "Tightness"
- Radiate: The sensation does not radiate
- Severity: 5/10
- Time: Patient admits to prior episodes.
A prolonged expiratory phase is noted.
Breath sounds: basilar rales
Vital signs are assessed.
- RR: 26
- Pulse: 80
- BP: 179/92
- SpO2: 84 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
By request here are the computerized measurements:
- HR: 78
- PR: 206
- QRS: 104
- QT/QTc: 430/490
- P-QRS-T: 23 -39 159
What is your interpretation of these ECGs?
How would you treat this patient and why?