Monday, 26 July 2010

58 year old female CC: Chest pain

Here's another case study from an international reader who wishes to remain anonymous.

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?

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