A 68-year-old male presents with a chief complaint of chest discomfort. It started at rest approximately three hours prior as has been constant ever since. He describes it as a burning sensation limited to the central portion of his chest. Nothing makes the pain better or worse and he rates it at about a 6 out of 10.
At a glance the patient appears pretty healthy. He is well-nourished, only slightly overweight, does not smoke, and feels fine aside from the nagging discomfort in his chest. There is no evidence of rash or discoloration over the area of discomfort. He denies nausea, vomiting, shortness of breath, diaphoresis, lightheadedness, syncope, or near syncope.
His skin in warm, pink, and dry and his radial pulse is strong, fast, and irregular.
Vitals are as follows:
- HR approx. 125 bpm, irregular
- BP 110/58 mmHg
- RR 18 /min and unlabored
- SpO2 96% on room air
- Temp 37.1 C (98.8 F)
Past medical history is significant for well-controlled hypertension, DVT/PE two years prior, and incidental coronary artery disease noted on a chest CT performed for the PE.
His medications include only amlodipine for hypertension and ongoing warfarin therapy for the prior PE/DVT.
Because of the patient’s chest pain and irregular pulse you perform a 12-lead ECG and see the following…
You also have immediate access to a copy of the patient’s ECG from two years prior, at the time of his PE/DVT…
How are you going to treat this patient?
Are you going to activate the cath lab?
Check out Part 2 for the rest of his initial course and management.
The case conclusion and discussion are in Part 3 (coming soon!).
created: 2013.12.30 last modified: 2017.08.29