EMS is called to the residence of a 88 year old male patient with a chief complaint of chest pain.
On arrival the patient is found standing at the front door. He appears anxious and acutely ill.
Skin is pink and warm but diaphoretic.
The patient is led to a kitchen chair and the assessment begins.
Past medical history: Hypothyroidism, Dyslipidemia
Medications: Synthroid, Lipitor
History of present illness:
The patient states that he was cleaning the house when symptoms began.
- Onset: Sudden and getting worse over time
- Provoke: Nothing make the pain better or worse
- Quality: Sharp
- Radiate: Pain radiates to the left arm
- Severity: 10/10
- Time: No previous episodes
Breath sounds are clear bilaterally.
No JVD or pitting edema noted.
Vital signs are assessed.
- RR: 20
- Pulse: 68
- NIBP: 145/85
- SpO2: 96 on RA
The patient admits to nausea but has not vomited. He denies palpitations.
The cardiac monitor is attached and a 12-lead ECG is obtained.
- HR: 66
- PR: 292
- QRS: 146
- QT/QTc: 414/434
- P-QRS-T: 21, -50, -19
What is your interpretation of this 12-lead ECG?
What do you think is going on with this patient?