A 48 year old Asian gentleman woke at 4am with crushing central chest pain, radiating to his left arm, associated with nausea ++, sweating++ and sob.

The patient took his own aspirin, but felt no better at 7am, when he called for an ambulance. He was previously was fit and well, although on questioning suffered with hypertension, NIDDM, hypercholesterolemia, smoked 7 cigars a day, and his father had had an MI in his early 50’s.

What are your ECG findings?

Would you thrombolyse?

Did the Paramedic make the right decision to thrombolyse?    

An 85 year old lady developed a sudden onset of central chest pain radiating to her left shoulder, no other associated symptoms. The pain was 8/10 at its worst and lasted for 15 minutes, at which point it began to resolve. The pain was sharp in nature. On assessment in A&E the pain was 3/10.

Current medication:

Digoxin—for atrial fibrillation for the last year.

What are your ECG findings?

Would you thrombolyse?  

An 84 year old lady presented to A&E after calling for an ambulance at 5am following a  collapse at 4 am. She reported no shortness of breath or loss of  consciousness, although she did feel nauseated and had vomited.

Surprisingly she was not complaining of any chest pain. She was normally fit and well and gave no past medical problems.

She was “red called” in as a collapse ? cause, as the paramedics were concerned about her condition. On arrival she was feeling very unwell.

What are your ECG findings?

Despite no chest pain would you thrombolyse?  

A 53 year old gentleman developed chest pain at 3pm at the end of his shift as a taxi driver. He described a sudden onset of chest pain rated 6/10. On arrival he was sweating profusely and looked pale and grey.

Unfortunately, he did not summons help till the pain became unbearable some 4 hours later at 7pm.

He had self medicated 300mg aspirin, in an attempt to resolve the pain.

He had smoked 20 a day for 31 years. He had no other risk factors and gave no past medical history.

His blood sugar level was recorded as 13.2mmols.

What are your ECG findings?

What treatment would you give? 

A 34 year old female came to Accident and Emergency, complaining of central chest pain, described as a tight sensation in her chest. The pain had started at 2pm as a heaviness and by 7.30pm it has become worse and was radiating down her left arm.

She vomited x2. She was given Aspirin and GTN in the ambulance.

At 9:49pm she arrived in A&E

She had smoked 15 a day since she was 12 years old.

Her father had MI x4 — 1^st at age 38

What are your ECG findings?

As soon as you see this ECG, what other information would you like?

This would be an urgent request? 

A 87 year old lady was found collapsed, by her next door neighbour, she was unresponsive, mildly SOB, cyanosed around her lips and has been incontinent of urine. She had a small haematoma on her head as a result of the collapse.

After 6 mins she regained consciousness and vomited x1, she had no chest pain, SOB, abdo pain, no new visual disturbance and didn’t feel any different in herself.

She was generally fit and well, having only a small amount of help with shopping and cleaning. She lived in sheltered accommodation.

She had had previous falls and had suffered  previously with TIA’s.

She was accompanied by her friend who gave most of the history as her family were all abroad.

This is her ECG on arrival:

What are your findings and diagnosis?

Would you thrombolyse, bearing in mind the lump on her head?  

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Last modified: 21-May-2009