Author: Diana George / Editor: Nick Tilbury / Codes: CC1, CC2, CP1, CP3, CP4, SLO1 / Published: 01/02/2022
A 44-year-old gentleman presents to the Emergency Department following a sudden loss of consciousness lasting for approximately 3 minutes. Immediately prior to this he had experienced palpitations and profuse sweating. He currently complains of a persistent tight, left-sided chest pain radiating to both arms, which has been intermittent for the last 2 days but persistent in the last few hours.
He initially ignored the pain as he thought it might be indigestion as he frequently gets the same feeling when he overeats.
His past medical history includes poorly controlled type-two diabetes mellitus.
His initial observations in the resuscitation room are:
- Heart rate – 76 beats per minute
- Blood pressure – 110/80mmHg
- Respiratory rate – 20 per minute
- SpO2- 99% on air
- Temperature – 37°C
- Capillary blood sugar – 24 mmol/L An ECG is performed and shown below.
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2. Question
Cardiology opinion is obtained and the patient is accepted for emergency percutaneous coronary intervention (PCI).
Which of the following coronary vessels is most likely to be involved in this scenario?
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3. Question
While awaiting transfer to the cardiac-catheter lab, one of your medical colleagues prescribes the patient some sublingual nitrates. The patient subsequently becomes pale and very hypotensive (BP-68/34mmHg).
What will be your next step in management?
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