Instructions
You are an intern in the emergency department. Your next patient is Jose Dela Cruz, 58, presenting with crushing central chest pain. His ECG is below.
Assess and manage the patient using an A to E approach
Take a focused history
Interpret the ECG
Outline to the examiner:
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
- A nurse will carry out your instructions
12-lead ECG on arrival
| Item | Value | Reference range |
|---|---|---|
| Rate | 58 /min | 60-100 /min |
| Rhythm | Regular; a P wave before every QRS, upright in II | Sinus |
| Axis | +30 degrees | -30 to +90 degrees |
| P waves | Normal morphology | Normal |
| PR interval | 210 ms, constant | 120-200 ms |
| QRS duration and morphology | 90 ms, narrow; no pathological Q waves | <120 ms |
| ST segments | Elevated 3 mm in III, 2 mm in II and aVF, convex upwards; depressed 1.5 mm in I and aVL; elevated 0.5 mm in V1; isoelectric in V2-V6 | Isoelectric |
| T waves | Tall and broad in II, III and aVF; inverted in aVL | Concordant with QRS |
| QTc | 420 ms | <450 ms |