Monday, 4 October 2010

78 year old male CC: Chest pain

EMS is called to the residence of a 78 year old male.

It's the middle of the night. The patient's spouse meets you at the front door and brings you back to the bedroom.

The patient is sitting on the edge of his bed. He is highly anxious and complaining of chest discomfort and palpitations.

Onset: During sleep
Provoke: Running made the sensation feel better earlier the previous day
Quality: An "electric" sort of "full" feeling in his chest
Radiate: The sensation does not radiate
Severity: 5/10
Time: Started earlier the previous day but went away after running

The patient takes several deep breaths during EMS evaluation and seems upset that it doesn't correct the problem.

Skin is pink, warm, and moist.

Breath sounds are clear bilaterally.

Vital signs are assessed.

RR: 20 and shallow
HR: 100
BP: 160/98
SpO2: 98 on RA

The cardiac monitor is attached.



A 12-lead ECG is captured.



And another.



What's going on here?

Could this be WPW?

Why or why not?