Best Case Ever 4 Acute Coronary Syndrome From Venous Source

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7 • 602 Ratings

🗓️ 6 June 2011

⏱️ 6 minutes

🔗️ Recording | iTunes | RSS

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Summary

In anticipation of Episode 15, 'Acute Coronary Syndromes' with Dr. Eric Letovsky, Dr. Mark Mensour and Dr. Neil Fam, we present here, Dr. Helman's 'Best Case Ever' of an ACS patient. In Episode 15: 'Acute Coronary Syndromes', Drs. Fam, Mensour , Letovsky and Helman discuss questions like: How does a recent negative stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require reperfusion therapy? [wpfilebase tag=file id=376 tpl=emc-play /] [wpfilebase tag=file id=377 tpl=emc-mp3 /]

Transcript

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0:00.0	Welcome to Emergency Medicine Case's Best Case Ever. This is Best Case Ever number four, which is in anticipation of episode number 15 on acute coronary syndromes, which will be released on the website at emergency medicine cases.com in about one week.
0:35.5	This time, rather than having one of our expert present their best case ever, I thought I'd
0:39.9	present my best case ever because I had this really interesting case a few weeks ago.
0:45.3	So this was a 30-year-old male who presented at 10 a.m. in the morning to my community hospital.
0:52.9	He was waiting for an aeroplane when he had an abrupt onset of
0:57.2	10 out of 10 sharp retraternal chest pain radiating to the left arm and jaw. It was constant.
1:04.1	It was associated with sweating and nausea. There was no shortness of breath. It wasn't
1:09.7	pleuritic. He had no fever. He had no risk factors for
1:13.0	DVT, except that he had been flying about one week prior on a long flight. There were no aortic
1:19.6	dissection risk factors, and the pain wasn't positional. In terms of cardiac risk factors,
1:26.7	the only traditional risk factor he had was smoking. In terms of cardiac risk factors, the only traditional risk factor he had was smoking.
1:30.3	In terms of non-traditional risk factors, he was not a cocaine user, wasn't HIV positive,
1:37.3	no lupus, no history of chronic renal failure, and no history of chronic steroid use.
1:43.3	These are the list of non-traditional
1:45.5	risk factors that I ask all my chest pain patients, especially the ones who are young and don't
1:49.9	have any traditional risk factors. On exam, he appeared to be in severe pain. He was diaphoretic and pale.
1:58.2	So, I did the usual. I got him into our resuscitation room. We hooked him up on the monitor.
2:04.6	His blood pressure was high at 176 on 126 and his pulse was a bit low at 42. The rest of his vitals were normal.
2:13.3	The first ECG showed sinus braticicardia with no ST changes.
2:18.7	I was starting to think maybe this could be dissection, so I did blood pressures in both
2:22.9	arms, which were equal. I looked for a pulse deficit. There was no pulse deficit.
2:27.0	And I listened carefully for an aortic regurgitation murmur, which can sometimes
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