81 year old male CC: "Cold and shaky"

An 81 year male reports to the fire station to have his blood pressure checked.

He tells the paramedics he had just finished a round of golf and was sitting in the clubhouse when he felt, "cold and shaky."

He relocated to his car with the windows rolled up and the A/C turned off. The ambient temperature was very warm but he still felt cold.

That's when he decided to drive to the fire station.

At the time of evaluation his BP was 120/70 and his pulse was 76 and regular, which was consistent with the other vital signs recorded on his BP card over the past 2 weeks.

When he left the fire station he did not appear acutely ill.

Two hours later an ambulance was dispatched for a male patient with shortness of breath.

The paramedics recognized the man standing on the side of the road wearing a jogging suit as the same man who was at the fire station earlier for a BP check.

He states that he called his doctor who was out of town, and the on-call physician advised him to call 9-1-1.

The man was helped into the back of the ambulance and undressed from the waist-up. A surgical scar is noted down the center of his chest.

Past medical history: MI and CABG x3 in 1985

Meds: Unknown

His vital signs were assessed.

Resp: 18
Pulse: 80
BP: 114/76
SpO2: 96 on RA

He states that "nothing has really changed" since he was at the fire station.

When asked about shortness of breath, he denies it.

The cardiac monitor is attached.

When specifically asked about chest discomfort he states, "Well, I do a little bit of chest pressure, but it's nothing like when I had my heart attack."

A 12-lead ECG is captured.

What is your impression?