A 40 year old gentleman admitted to Accident and Emergency.

Was working on the roof when he developed some chest pain which he rated 8/10, he became sweaty and looked pale. From his symptoms his wife thought he was having a heart attack and called for help.  

This is a copy of his ECG on arrival. 

What are your findings?

Would you thrombolyse?   

On arrival at A&E his pain had completely resolved and the ST elevation you can see above and disappeared. Later on CCU he had further pain, his ECG now looks like this. What are your findings and action now?

Case 37                      

A 61 year old gentleman presents to A&E following a visit to his GP today. He had had 7 episodes of chest pain today, the worst being one he scored 8 out of 10 which had occurred shortly before seeing his GP at 14:30hrs.

he described a dull central chest pain, associated with nausea, each episode only lasted 3-4 minutes, after which it then settled. he remained pain free between episodes.

He was known to have hypertension, and a peptic ulcer 20 years ago.

On his arrival the technician crew asked one of the cardiac nurses if he would be a candidate for Resus. Having shown the ECG below he was move in to Resus for further treatment.

What can you see on the ECG?         

after about 45minutes in Resus he described the same pain returning, fortunately the ECG was still attached and this now how the ECG looked, despite not being the best trace (taken in a bit of a hurry!) what is now happening on the ECG?   

sure enough after about 3 minutes the pain settled and he became pain free. The ECG returned to the same as the 1st ECG. He was blue lighted to the GGH for PCI within 30 minutes. He was found to have a critical lesion on his LAD (left anterior Descending) Artery. He had a direct stent

Case 38                  

A 80 year old lady presented at 04.30hrs, after having chest pain continuously for 3 hours. She felt short of breath.

The pain had been on/off throughout the day, scoring 5/10 The Pain had eased earlier with GTN but kept coming back. At about 01.30hrs the pain became significantly worse since , it now scored 10/10

The pain radiated to her left arm

Risk factors

Ex smoker

Cholesterol 6.6mmols

What can you see on the ECG?  

Could this infarct be older than 12 hours?

Would you thrombolise? 

A 45 year old female had been to her GP a few days ago following a few episodes of chest pain. It had been at rest, and had radiated down her left arm.

The pain had been slightly worse on deep inspiration, and at times she described it as a burning / sharp pain.

At about 11pm this evening, it had become worse, now describing it as a heavy left sided chest pain, associated with SOB, sweating, and pain in the left arm.

Heavy life smoker 25-30 day

What are your ECG findings? 

Would you thrombolise?  

An 80 year old gentleman presenting at 4.30 am, via the ambulance service having had 3 hrs of chest pain.

It was associated with shortness of breath. The pain had been on and off throughout the previous day but and become constant since 1.30am.

It was also far worse than it had been scoring 10/10, were as it had only been 5/10 throughout the day, when it also responded to GTN.

He also complained of pain radiating down the left arm

Risk Factors

Ex smoker 25 day for 45 years, stopping 6 years ago.

Chol 6.6

What are your ECG findings? 

Would you thrombolise?  

A 45 year old female had been to see her GP a few days ago with chest pain, who diagnosed muscular skeletal pain.

The pain was described as being slightly worse on inspiration, and at times radiated down her left side, which had come on at rest.

she was a heavy life smoker of 30 day, starting when she was 16 years old.

To confuse the picture she also complained of the pain being burning and sharp at times.

What are your ECG findings? 

 Later on CCU she complained of further pain and an ECG was performed

What are your ECG findings? 

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Last modified: 21-May-2009 22:02