50 Year Old Male: Chest Pain, Hypotension, Pulmonary Edema

Physician and cardiovascular fellow Dr. Musa A. Sharkawi shared this ECG on Twitter (@MusaSharkawi) and has graciously allowed us to reproduce it here. A 50-year-old male presents with a chief complaint of abrupt-onset severe chest pain. He is pale, diaphoretic, and ill-appearing—in moderate respiratory distress with extensive biateral crackles and a low blood pressure. Further history is limited by the patient’s condition but listed below: Onset – 30 min ago Provocation/Palliation – None Quality – Severe “crushing” pressure Radiation – None Severity – 10/10 Timing – Constant Signs/Symptoms – The patient ate dinner approximately an hour ago and soon noted that he felt generally unwell. He sat on the couch to rest but then developed severe chest pressure followed by a single episode of vomiting. He currently feels like something is crushing his chest with severe shortness of breath and weakness. Allergies – No known drug allergies Medications – Metformin, lisinopril, aspirin, hydrochlorothiazide Past Medical History – Type II diabetes, hypertension, chronic kidney disease (unknown stage) Last Oral Intake – Dinner 1 hour ago Events Preceding Presentation – See above Temperature – 36.7 C (98.1 F) Heart Rate – 100 bpm, irregular Blood Pressure – 86/50 mmHg Respiratory Rate – 30 /min, labored SpO2 – 83% (room air) General – Ill-appearing male in severe distress. Vomit noted on patient’s mouth and chest. Skin – Pale, c...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: Cases Vince DiGiulio Source Type: research