Tuesday, August 22, 2017

A 55 Year Old Man Presents To Emergency With Chest Pain For 6 Hours...

The ECG shown below was recorded in the A & E department from a 55-year-old man who had had chest pain at rest for 6 hours. There were no abnormal physical findings.
What does the trace show, and how would you manage him?


The ECG shows:
• Sinus rhythm
• Normal axis
• Normal QRS complexes
• ST segment depression - horizontal in leads V3-V4, downward-sloping in leads I, VL, V5-V6


Clinical interpretation
This ECG shows anterior and lateral ischemia without evidence of infarction. Taken with the
clinical history, the diagnosis is clearly 'unstable' angina.

Diagnosis
Anterolateral ischemia.

What to do
There is no evidence of any benefit from thrombolysis. The patient should be given aspirin and intravenous heparin and nitrates. At the time the record was taken, he had a sinus tachycardia (at a rate of about 130/min) and if this does not settle quickly, intravenous beta-blocker would help.

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