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Case presentation

A 65 year old male complains of 6 hours stuttering left chest pain that is now radiating to his jaw

Case study: A 65 year old male complains of 6 hours stuttering left chest pain that is now radiating to his jaw

1.

What does this ECG show?

Rate 100 bpm
Rhythm Sinus
ST Elevation Yes
Which Lead I, aVL, V4, V5, V6
Location (if STEMI) Lateral

 

In the diagrams below, the green line represents the electrical baseline found by connecting multiple TP segments. You can see ST elevations in leads, I, aVL, V5, and V6, which represent the lateral wall of the left ventricle.

Case study

Case study

2.

How would you manage this patient?

After noting ST elevations in two contiguous leads, the EKG should be transmitted for advance notification and review by the Emergency physician and Cardiology team. Regardless of EKG findings, this patient with chest pain should receive Aspirin 162mg-324mg PO. NTG 0.4mg SL should be administered for chest pain if his blood pressure is appropriate (SBP >100) and he has not used sexually enhancing drugs in the past 24 hours.

By Shira Schlesinger MD, Los Angeles EMS Agency
Acknowledgements: The EMS Agency would like to thank Dr. James T. Niemann for his contribution of the above ECG