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Saturday, November 28, 2009

Chest Pain AMA

Just as shift change was happening we were toned out for a medical aid. We responded for a woman with chest pain. Upon our arrival we found our patient waiting for us in the garage. As she led us inside her house she explained that about 10 minutes prior to our arrival she had been driving home from dropping her kids off at school when she started having heart palpitations.She also experienced shortness of breath. She described it as a pleuritic chest pain that only lasted about 5 minutes. She also informed us that she had a history of anxiety and had taken a Valium when she got home to calm herself down. Our patient, a 46 year old woman, had had several episodes similar to this one over the past several months. Each time she had been seen by either the ER physician or her cardiologist but they had found nothing wrong with her heart. After doing a full work up, and not finding anything, she stated that her husband was on his way home and she would prefer to let him take her to the cardiologist instead of going to the ER. We signed her out AMA and went on our way.
http://www.aafp.org/afp/20021101/1695_f2b.gif
This is an example of a heart rhythm that we are hoping not to find. In leads II, III, and aVF there are large humps that aren't supposed to be there. This is called tombstoning (it's shaped like a tombstone and the person is quickly headed for one) and is indicative of an MI. This person would need to get to a angio-cath lab right away.
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