Canadian Journal of Rural Medicine

THE PRACTITIONER
Year
: 2019  |  Volume : 24  |  Issue : 1  |  Page : 23--24

Country cardiograms case 65


Charles Helm, Matthew Embree 
 Tumbler Ridge Health Centre, Tumbler Ridge, Canada

Correspondence Address:
Charles Helm
Tumbler Ridge Health Centre, Tumbler Ridge
Canada




How to cite this article:
Helm C, Embree M. Country cardiograms case 65.Can J Rural Med 2019;24:23-24


How to cite this URL:
Helm C, Embree M. Country cardiograms case 65. Can J Rural Med [serial online] 2019 [cited 2019 Nov 22 ];24:23-24
Available from: http://www.cjrm.ca/text.asp?2019/24/1/23/248417


Full Text

 Question



A 69-year-old male patient presents to a remote British Columbia Emergency Room with chest pain. The pain has been intermittently present for approximately 5 days, and he had initially presented 3 days earlier, at which time, an electrocardiogram (ECG) was recorded [Figure 1]. At that visit, his troponin level was negative (<40 ng/L).{Figure 1}

He is a lifelong non-smoker, without a family history of premature coronary artery disease. He takes ramipril for elevated blood pressure and takes rosuvastatin for an adverse lipid profile. He is not known to be diabetic. His weight is 100 kg.

He presents now because the pain worsened about an hour ago, with radiation for the first time into the left arm. Vital signs include a pulse of 80/min, blood pressure of 130/80 mmHg, respiratory rate of 16/min and oxygen saturation of 97%. Heart sounds are normal, and the chest is clear to auscultation, with no peripheral oedema evident. Another electrocardiogram is obtained [Figure 2].{Figure 2}

The computer interpretation reads: 'ST elevation – consider anterior injury or acute infarct'. What is your interpretation, and what are the next steps? Is thrombolysis indicated?