Presenting Complaint - Chest Pain
History of Present Complaint - 58 year old female, nil cardiac history, mild smoker, social drinker and overweight.
Complaining of acute central chest pain @ rest. Awoken by pain.
On Arrival - Sat upright on settee (Editor's note: One of you Brits will have to interpret that for me!)
On examination:
Alert, orientated and communicable (GCS 15)
Pale, cool dry skin.
Nil SOB, clear bi-lateral air entry - nil adventitious breath sounds
R/R 19, SpO2 99%
H/R 68 and irregular, BP 125/74
Temp 36.8
B.M 7.2 (Editor's note: B.M. is BGL measured in millimoles. 1 mmol/L of glucose is equivalent to 18 mg/dL. Hence, this patient's sugar is about 130).
C/O chest pain.
O - Acute. Awoken from sleep.
P - Nothing makes pain better. Not affected by breathing
Q - Non specific compressing type pain
R - Central chest pain radiating left arm
S - Pain score 6/10
T - 30 mins
I - No pain intervention sought.
Slight nausea, nil vomit
The cardiac monitor is attached.
A 12-lead ECG is captured.
Once again, I am impressed at the power of Web 2.0.!
Getting case studies like this from thousands of miles away is a real privilege and it makes me very happy to be able to share them with my colleagues from around the world!
This ECG meets all 3 of a certain criteria.
What criteria are we talking about and how would you treat this patient?
While you're at it, please CLICK HERE if you missed my previous post and cast your vote!
Very nice one really sick patient but obviously because of her under lying health concerns she should make a good recovery, but if non of that changes only one way for this type of patient, the worst is she is probally set in her ways....endless medication...
ReplyDeleteits an acute inferolateral STEMI(high lateral), do right chestleads/echo (to check RV infarction/function/guide management), arranged immediate pci/stent if capable or fibrinolytics (if a good candidate),standby pacing for common potential complication of IWMI such as AV blocks/sinus node arrhythmias plus(pt had LBBB) and left axis deviation. this patient sick...close observation.
ReplyDeletei see inferior STEMI and lateral MI appear in 1st ecg and in 12 lead ECG i see LBBB also
ReplyDeletei think she should receive thrombolytics therapy as strepto and put on monitor
Nice!. Very usefull when present, but then again most often absent in STEMI + LBBB.
ReplyDeleteCheers.
Ref.
Elena.B.Sgarbossa et al; New England Journal of Medicine, Volume 334 ;Number 8, FEBRUARY 22, 1996.
Due to inability to diagnose MI in the event of LBBB cardiac markers need to be taken to identify if a evolving MI is present
ReplyDeleteSettee = sofa. Nice site. Thanks.
ReplyDelete