37 Year Old Male–CC: Chest Pain, Part II

This is part II to "37 year old male–CC: Chest Pain". You may wish to review the case. So, while many of our cases are straightforward, this one is not.  But hey, our patients don't read the textbooks! First, let's review the chief complaint:  Our 37 year old male had "chest tightness", but complained of lethargy and "chills" for at least a couple of days. While we must take the complaint of chest pain seriously, many of you pointed out that the history did not seem like typical ACS. We can't blow off chest tightness, but the history is no slam dunk.  Here again is the 12 lead ECG: There is sinus rhythm at a rate of about 83 bpm. Axis is normal. QRS is slightly widened. PRI is normal, and we can debate whether or not there is slight PR segment depression. There is some artifact present. Using the TP segment, there is slight (<1mm) STE in leads II, III, aVF, V5 and V6. If you use the PR segment, which may have some slight depression, you will see a bit more ST elevation. All ST segments are upsloping. Regarding V2-V4, is there any ST elevation? Some will say yes, but there is some wandering of the baseline, and I am not convinced. If there is any, it is a small amount. All ST segments seem to be concave up. There is no reciprocal ST depression. We do not have the computer interpretation/measurements for this ECG.  What do we make of this ECG? Again, as in the history, no slam dunk. I th...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ems-health-safety patient-management Training training-development Source Type: research