In his own words:
Presenting Complaint - Chest Pain
History of Present Complaint - 69 year old male, nil cardiac history, none smoker, social drinker.
Complaining of indigestion last 2-3 weeks with noticably increase in belching.
This a.m acute onset of burning heavy central chest pain radiating to neck.
On Arrival - Semi-recumbent in bed
On examination:
Alert, orientated and communicable (GCS 15)
Pallor
Diaphoretic
Nil SOB, clear bi-lateral air entry - nil adventitious breath sounds
R/R 16, SpO2 98%
H/R 90 and irregular, Hypertensive 168/110
Temp 36.5 C (97.7 F)
B.M 9.0
C/O chest pain..
O - Acute
P - Nothing makes pain better. Not affected by breathing
Q - Heavy in chest, burning in throat
R - Retrosternal and radiating to neck
S - Pain score 10/10
T - 15 mins
I - No pain intervention sought.
Nil nausea, nil vomit
The cardiac monitor is attached.
A 12-lead ECG is captured.
The patient loses consciousness and the monitor shows ventricular fibrillation. A shock is delivered at 200J.
The patient experiences return of spontaneous circulation.
A few minutes later the heart rhythm returns to baseline.
What is this patient's problem?
