ECG case series for paramedics: August 2024

02 August 2024
Volume 16 · Issue 8

This 58-year-old man lives in a remote and rural area and presents with central chest pain.

He normally keeps fit and well and has no pertinent medical history. He was out for his usual morning jog. He had run for several miles when he became acutely unwell. He had developed a heavy, pressing central chest pain that radiated into his jaws and down both arms. The pain was severe and he rated it as 9 out of 10. He vomited several times. He managed to return to his car and drove himself home. However, he continued to feel very unwell and called for an ambulance. He suspected he was having a heart attack.

His vital signs were as follows:

  • Blood pressure: 120/78 mmHg
  • Pulse: 75 beats per minute
  • Respiratory rate: 16 breaths per minute
  • He was apyrexial l SpO2 on air: 97%.
  • The 12-lead electrocardiogram (ECG) in Figure 1 was recorded.

    Figure 1. ECG of a 58-year-old man presenting with a heavy, pressing central chest pain

    Interpretation of the ECG rhythm

  • The heart rhythm is regular
  • The heart rate is approximately 75 beats per minute
  • The rhythm is sinus rhythm
  • The cardiac axis is normal (positive QRS complexes in Lead I and aVF).
  • There is ST segment elevation of approximately 5mm across his chest leads V1–V5. There is no T wave inversion or pathological Q waves. This suggests a hyperacute anterior septal ST elevation myocardial infarction (STEMI).

    Coronary angiography revealed an occluded proximal left anterior descending coronary artery. A single stent was inserted. He went on to make an uneventful recovery.