A 50-something woman with chest pain and dyspeoa (an Aussie)

This case comes from Max Nelson, a paramedic in Australia.See also this post:40-something with severe CP. True + vs. False + high lateral MI. ST depression does not localize.CaseI was dispatched to a middle age woman (~50YO) with chest pain and nausea.Exam: pt is huddled around toilet bowel, naked and shivering. Pt appears “well” but with pallor.Hx: pt was woken from sleep after midnight with chest aching, dyspnoea and significant nausea. Pt moved to the toilet and had one bilious vomit. The ambulance was called and arrived approx 20 minutes later.Signs and symptoms: nausea, dyspneoa, cold, pallor.Now states chest pain/tightness has resolved (gone).Hx of pain:D- achingO- tonight roughly 30 minutes before assessment. First experienced 2 days ago while “rushing at work” with several intermittent pains since then.L- central chestO- nausea, dyspnoea. Unchanged on inspiration, palpation, movement.R- nil radiation, relieved tonight with vomit, relieved past two days with rest, rated 7/10 (not current).Risks: postmenopausal woman, paternal CABG. Non smoker.Allergy: penicillinMedication: anti-depressantPast medical history: depressionVSS: GCS 15, PERRLA, 140/80, 96BPM, 22RPM, 98% ORA, 35.5*C, 6mmol/L.Here is the ECG,after patient ' s pain has resolved:Automated interpretation: NSR,NormalWhat do you think?Smith comment: I see significantST depression in inferior leads.   Remember that when there is inferior ST depression, it is NOT " inferior ischemia, " as subendoca...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs