A 79-year-old lady, who arrived in A&E at Midday

She had had pain since yesterday morning, not sure what time it started. She was a poor historian.

The pain was heavy in nature – a “band like” pain, the pain now worse on deep inspiration and associated with SOB and sweating.

She had been seeing her GP for last 3 months for pain between her shoulders with no diagnosis.

Risk factors Smoker 15 day for life

                    Hypertension 

The ECG changes are? 

Which thrombolysis would you use?         

A 65-year-old male, arrived at A+E with a 5 day history of chest pain radiating down left arm. No other associated symptoms

Smoker of 20 a day

Drinks 10 units 3-4 times a week 

What are your ECG findings?

What is your treatment?      

A 91 year old lady was red called to the emergency room from ambulance control. She described a heavy pressure type pain in the centre of her chest, she had been resting when the pain had come on, rated 9/10. She was sweating, SOB and felt nauseous. The pain had started some 1 ½ hours ago. 

PMH Hypertension 

She lived in residential/sheltered accommodation and was normally fit and well. Completely self caring and independently mobile. She looked young for her age, and you could have mistaken her for being less then than 70 years of age. 

Here is the ECG, what do you do now?

What can you see on the ECG, is it thrombolysable and would you do it?       

A 73 year old male, presented in A&E complaining of feeling dizzy for four days. He complained of his head spinning, but no loss of consciousness, he has had no chest pain, but has been feeling tired and lethargic. He had been due to go swimming that morning but had felt too unwell.

He was known to be a non-insulin dependant diabetic and had previously had an Myocardial infarct in 1986.

This was his ECG on admission, what are your findings?

What is the most likely treatment for your findings?.                

A 52 year old male presented with chest pain which had started at 9am, it radiated  to his left arm. He didn’t feel short of breath and had no nausea, although he did feel clammy and sweaty.

He had a past medical history of a peptic ulcer 18 years ago. 

His cardiac risk factors included being an ex-smoker and his father had had an MI in his 60’s. 

What are your ECG findings?

Would you thrombolyse?           

A 72 year old lady presented in A&E with palpitations. She was known to have atrial fibrillation and regularly experienced palpitations. 

Today she experienced a sudden onset of a dull, central, retro-sternal ache. It radiating to her throat, jaw, ears and shoulders. She felt sweaty and short of breath. The pain was very intense.

A smoker of 10 a day for 50 years she stopped 12 years ago. 

What are your ECG findings?      

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