ECG Changes

It’s pouring rain and we get called for anxiety. 40 year old female sits in her kitchen holding her chest saying it feels heavy. We ask if she has been under stress and she says, “You don’t want to know.”

But she has never felt a pressure like this before and she says it feels like someone sitting on her chest. Her skin is warm and dry. BP 150/90. P- 108. Sat 100% on room air.

No prior history, though given her race and weight, she looks like she might have hypertension and high cholestrol.

Out in the ambulance, I put her on the monitor. Doesn’t look too bad at first glance. Of course I am just looking at the inferior leads.

This could just be stress I tell her, but we are going to treat you like its your heart. We’re required too.

I do a 12 lead.

Looks a little suspicious. V-6 is troubling. V-5 just a touch. The inferior leads look ever so slightly up. Maybe it is just a variant for her.

I give ASA and NTG, which brings no relief. Her pressure holds steady. I call the hospital, and let them know I have a chest pain with a borderline ECG, possible ST elevation in lateral leads.

I do another 12-Lead. The patient asks how it is. She sees something in my face as I stare at it.

Holy. Looks nasty. Particuarly in V-4 -V6. Such a change in ten minutes. In addition to the lateral there is fresh change inferiorly with an ominous cove shaping of the ST.

At the hospital I tell the triage nurse I believe my patient is having an MI. She says they are getting a room ready for us. I ask who the doctor is. She tells me it is a new physician and points in her direction. Sitting next to her I see one of hospital’s best physicians, who is very EMS oriented. After I give a report to the nurse and get the patient on the bed, I go over to the doctor I know and show him the strips. He asks what room and I tell him. He immediately shows the strips to the new physician. He tells her the process for calling the cath lab.

I write my report and as I am bringing it back to the room, they are already wheeling the patient out, headed to the cath lab.

Nice turn around.