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June 12, 2012

ECG Challenge: Winter, spring or summer

EMS is called to the residence of a 68-year-old male complaining of chest pain.

The patient was working in the yard when symptoms began.

At the time of EMS arrival, the patient appears acutely ill. He is grayish in color but very warm and diaphoretic. He is nauseated and has vomited prior to EMS arrival.

Past medical history: Hypertension, dyslipidemia
Medications: Hyzaar (HCTZ and losartan), Mevacor (lovastatin)
Onset: 30 minutes prior to EMS
Quality: Pressure or heaviness
Radiate: The pain does not radiate
Severity: 9/10

Nothing makes the pain better or worse. The patient says he has had no previous episodes, "at least not like this." 

Vital signs are assessed:

  • RR: 20
  • HR: 74
  • NIBP: 110/75
  • SpO2: 92 on RA

The patient admits to mild dyspnea although breath sounds are clear bilaterally.

The cardiac monitor is attached.

A 12-lead ECG is obtained.

You are 20 minutes from the local community hospital and 40 minutes from a PCI center.

What is your interpretation of this ECG?

Should you call a Code STEMI?

How would you treat the patient?