Case Study

Your patient is a 70 year old male who is experiencing “chest heaviness”.

1. List the 3 most life threatening conditions which could be responsible for his chest heaviness.


1. Acute myocardial infarction
2. Pulmonary embolism
3. Aortic dissection

You record the following ECG. (Right click on the image, then select “Open in new window” to enlarge)

What is your interpretation of the ECG?


Rhythm – normal sinus rhythm
Axis – left axis deviation
Chamber size – none
Conduction problems – right bundle branch block, left anterior hemiblock
Ischemia – anterolateral STEMI; reciprocal ST depression III, aVF
Miscellaneous – none

What are your treatment priorities?


1. Notify receiving facility “STEMI Alert”
2. Transmit ECG
3. Begin transport to cardiac intervention center
4. Administer NTG and ASA
5. Place combo pads
6. Gain vascular access
7. Notify / consult
8. Obtain additional traces

What should you anticipate with this patient presentation? Answer

Patients who present with anterior wall STEMI are at high risk for developing ventricular dysrhythmias, sudden cardiac arrest, and pulmonary edema. Be prepared to aggressively treat with electrical therapy and CPAP, respectively. Be sure to notify the receiving facility early and continuously monitor the patient’s mental and respiratory status, cardiac rhythm, and vital signs.


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