Squiggler

Central chest heaviness with nausea for ninety minutes

The case

47-year-old man. Central chest heaviness with nausea for ninety minutes

Smokes twenty a day. No regular medication and no rate-limiting drugs. Brought in by ambulance; the pain started while he was carrying boxes and has not eased.

On arrival

HR
51
SpO₂ (%)
97
Respiratory rate
16
Temperature (°C)
36.6
Systolic BP (mmHg)
118
Diastolic BP (mmHg)
72

Stage 1 of 1

Gareth Whitlock is grey and sweating but talking in full sentences. The chest is clear, the heart sounds are normal and the abdomen is soft. He has vomited once in the ambulance. This twelve-lead was recorded three minutes after he arrived, with the heaviness still there.

The tracing for the quiz “Central chest heaviness with nausea for ninety minutes”.
Twelve-lead recorded on arrival, 25 mm/s, 10 mm/mV. Open this tracing in the studio
What do these twelve leads show?
The ventricular rate is 51. What does the tracing show about the mechanism?
What could be a bedside diagnostic to strengthen the diagnosis?

Diagnosis

Acute inferior ST-elevation myocardial infarction with sinus bradycardia

Always consider the possibility of a posterior STEMI when there is ST segment depressions in anterior leads. You should be prompted to scrutinize especially inferior leads for subtle ST elevation. Posterior leads could be an adjunct but is not necessary in typical posterior MI ECG:s.

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Or, where scripts are stripped:

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This tracing was generated, not recorded. It opens in the studio with every dial live.

Open the studio

Discussion

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