Monday, 1 March 2010

63 year old male with sudden onset shortness of breath

This is an interesting case submitted by Tom Bernesser who is a paramedic from North Carolina.

I got to know Tom through the EKG Challenge forum at the EMS Village where he always posted fascinating case studies.

Here's the story.

63 year old male presents with acute onset of dyspnea.

He reported 4 previous MI's with similar presenation, only dyspnea - no pain or discomort as was the case on this morning.

Past medical history:

NIDDM, HTN, MI, CHF, CVA and is bed-confined for the most part. He's also fairly obese.

Vital signs:

BP of 146/90
HR 104
RR 24
SpO2: 87 on RA, 100 on O2 via NRB mask @ 15 LPM

BGL: 141 mg/dL.

He did have diminished lung sounds bilaterally, maybe some rales in the bases but was able to speak in full sentences.

He also had some pedal edema, but wasn't taking any diuretics.

He's at a Skilled Nursing Facility (SNF) but of course there is no old EKG on site for comparison.

Another note, he did have occasional bouts of multifocal PVC's probably about 10-15/min.

Here is the 12-lead ECG.

Here is the computerized interpretive statement.

As you can see, it's giving the >>>> ACUTE MI <<<< message.

Would you activate the cardiac cath lab?

Why or why not?