46 year old male chief complaint of chest pain with no signi | Figure 1

espilker
Paramedic

Case Summary
46 year old male chief complaint of chest pain with no significant cardiac history. Began acutely and rates pain 6-9 in quality. Patient's vitals were assessed and observed as follows:

Blood pressure: 143/81 mmHg
Pulse: 96 bpm, regular, radial a.a.
Respirations: 18 cycles/min non-labored
Orientation: AAOx4, GCS 15
Spo2%: 99% at room air
ECG: initially showed this rhythm in Figure 1 and 2. sinus origin with q waves and progressing ST-ELEVATION observed in ll, lll and aVF
Blood glucose: 103.0 mg/dl

Medical History: Unremarkable
Patient was administered aspirin, oxygen, and nitroglycerin per ACS protocol. During transport to hospital patient became increasingly more diaphoretic, dyspneic, and lightheaded and lost consciousness. Patient lost pulses and entered rhythm on Figure 3. Patient was defibrillated at 150.0 J and cardiovascular rhythms were observed in Figures 4 and 5.

Paramedic did not recognize evolving STEMI until cardiac arrest. Can you recognize subtle changes that give evidence of STEMI?

This case documents a progressive inferior STEMI progressing to vfib, and being successfully cardioverted. I can't take credit for this particular case but I am posting for my colleague who performed an outstanding job here. Plus it shows a remarkable progression of ACS to cardiac arrest to cardioversion with a positive prognosis.

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Case Discussions:

Can you recognize subtle changes that give evidence of STEMI?
Are there any significant findings in the capnography waveforms?
Do you see any subtleties that may provide evidence of what caused loss of consciousness?

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