ECG Challenge: Just a little depression

EMS is called to a 66 year old male complaining of chest pain. On arrival the patient is found sitting in a chair outside his residence. He had apparently been gardening when he became acutely ill.


Editor’s Note:

Editor's Note: Check out this month's ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

--> UPDATED: 07/12/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

This month we're trying something a little different and withholding the computerized interpretation until the solution is posted.

EMS is called to a 66-year-old male complaining of chest pain.

On arrival the patient is found sitting in a chair outside his residence. He had apparently been gardening when he became acutely ill.

Onset: 30 minutes prior to EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: "Crushing pressure"
Radiate: The pain does not radiate
Severity: 10/10
Time: He admits to having an episode of chest pain 1 week ago "but not like this"

Past medical history: HTN, high cholesterol, cholecystitis
Medications: ASA, lisinopril, rosuvastatin

Skin is cool, pale and diaphoretic.

Breath sounds are clear bilaterally.

The patient denies shortness of breath but admits to nausea. He has not vomited.

Vital signs are assessed.

RR: 12
Pulse: 68
BP: 98/54
Temp: 98.0
SpO2: 98 on RA

BGL: 108

The patient is placed on the cardiac monitor.

A 12-lead ECG is captured with the following computer measurements.

HR: 66
PR: 170
QRS: 116
QT/QTc: 440/461
P-QRS-T: 37 -49 177

What do you think of this 12-lead ECG?

Would you call a STEMI Alert based on this 12-lead ECG? Why or why not?

How would you treat this patient?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the EMS12Lead.com, Chief Content Architect of ECGMedicalTraining.com, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at tom.bouthillet@ems1.com.

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