71 year old male: Chest Discomfort


This very interesting case comes from Bryan F, a Paramedic from Long Island.

A 71 year old male is cooking breakfast when he experiences sudden onset of 10/10 chest discomfort. He waits 20 minutes or so for it to subside, but it does not and he calls 911.

EMS arrives to find him lying in bed, stating the chest “pressure” has subsided somewhat (6/10), but he now feels some discomfort in his left shoulder. He has never experienced this before.

He denies any shortness of breath, diaphoresis, n/v, or numbness/tingling.

His Vitals:

  • HR: 74, slight sinus arrhythmia
  • BP: 178/96
  • RR: 20, regular, lungs clear,  SpO2 97% on RA
  • Skin: Pale and dry

He has taken 324 ASA prior to EMS arrival, and SL NTG and 50 mcg of Fentanyl are additionally given.

Here are two of the 12 lead ECGs:



In the time between ECG #1 and #5 shown above, approximately 30 minutes, there were no obvious changes or evolution. You are about 25 minutes from the hospital.

Would you call a STEMI alert?

Why or why not?




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Author: David Baumrind

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