Emergency · History + examination

Crushing chest pain

Medium

15 min station · 2 min reading · Recommended for Curtin Year 5 students

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X H V C

2 min reading · 15 min station · reminders at 2 min

Instructions

You are a medical student on placement in the emergency department. Your next patient is Rahul Singh, 76, presenting with central crushing chest pain. His ECG is below.

  1. Take a focused history

  2. Perform a cardiovascular examination

  3. Outline to the examiner:

    • Your findings
    • Your interpretation of the ECG
    • Your most likely diagnosis and differentials
    • Next steps in management, including relevant investigations

ECG

ECG
ItemValueReference range
Rate92 bpm60-100 bpm
RhythmRegular sinus rhythm-
AxisNormal-
P wavesNormal, one per QRS-
PR interval180 ms120-200 ms
QRS duration90 ms<120 ms
ST segmentsHorizontal ST-segment depression 0.5 mm in V2-V4; T-wave inversion in lateral leads V5-V6, II, and aVL-
T wavesInverted in V5-V6, II and aVLupright or biphasic
QTc420 ms<440 ms
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Investigations

Examination

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