Tag Archives: chest pain

Story 17 STEMI.31 F. Naaah.Really!!

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READING TIME 4 MINUTES

Case has been storified to protect confidentiality 

At Storifield Royal 04:15

I was in the later half of my night shift and was looking forward for my break. Almost there. I could smell the coffee. Just then I got thrusted with an ECG and 2 words

CHEST PAIN 

         SIGN PLEASE

Here are the 2 ECGs that were done 15 minutes apart

0652

0552

and this was my reaction to it

 

ST elevation can be seen  in lead II,III,AVF,V2-v4.

As I walked towards the patient, I saw a young lady sitting on a chair clenching her chest with her left hand and holding a 5 week old baby with the other. She said I woke up with this crushing chest pain. I feel I have been kicked in the chest. Pain was heavy, not worsening with breathing. She had cold sweats and was feeling nauseated. There were no co-morbids.

Nurse shouted her pulse is 56,  BP 138/66, SpO2 97% on air. She is afebrile. We got her on the trolley, moved her to resus, cannulated and gave her analgesia.

Examination was unremarkable.

Cardiologist were called and a decision to activate the cath lab was taken. Reluctant to let go of her baby, we reassured mom that both of you will be reunited soon.

Angiography showed that patient had developed Spontaneous Coronary Artery Dissection(SCAD)

dissection

The culprit vessel was successfully stented and she made a full recovery.

Check out this 30 second animated demonstration on SCAD

learningpoints

Inspirations:

Spontaneous coronary artery dissection—A review

SCAD: current insights and therapy