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58 year old female CC: Chest pain

Posted Jul 25 2010 6:27pm
Here's another case study from an international reader who wishes to remain anonymous.

Presenting Complaint - Chest Pain

History of Present Complaint - 58 year old female, nil cardiac history, mild smoker, social drinker and overweight.

Complaining of acute central chest pain @ rest. Awoken by pain.

On Arrival - Sat upright on settee (Editor's note: One of you Brits will have to interpret that for me!)

On examination
Alert, orientated and communicable (GCS 15)
Pale, cool dry skin.

Nil SOB, clear bi-lateral air entry - nil adventitious breath sounds
R/R 19, SpO2 99%

H/R 68 and irregular, BP 125/74

Temp 36.8
B.M 7.2 (Editor's note: B.M. is BGL measured in millimoles. 1 mmol/L of glucose is equivalent to 18 mg/dL. Hence, this patient's sugar is about 130).

C/O chest pain.

O - Acute. Awoken from sleep.
P - Nothing makes pain better. Not affected by breathing
Q - Non specific compressing type pain
R - Central chest pain radiating left arm
S - Pain score 6/10
T - 30 mins
I - No pain intervention sought.

Slight nausea, nil vomit

The cardiac monitor is attached.


A 12-lead ECG is captured.



Once again, I am impressed at the power of Web 2.0.!

Getting case studies like this from thousands of miles away is a real privilege and it makes me very happy to be able to share them with my colleagues from around the world!

This ECG meets all 3 of a certain criteria.

What criteria are we talking about and how would you treat this patient?

While you're at it, please CLICK HERE if you missed my previous post and cast your vote!
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