| A
56 year old male presents to the ER after sudden onset of Shortness
of breath this morning. He states that he was in his usual state
of health when he awoke from his sleep early this morning with "The
feeling like I couldn't catch my breath" He said it was so
difficult even to go to the bathroom with out being really out of
breath. He also says that he feels like his heart is going "a
mile a minute". He said his wife got really worried and she
convinced him to call 911. He denies at any point any chest pain,
dizziness, nausea, vomiting, cough, sputum production. He denies
any toxic habits. His past medical history includes prostate cancer
for which he is currently receiving therapy for, and asthma. He
denies any surgeries, or drug allergies. He is currently only taking
ADVAIR, albuterol for rescue and the regiment prescribed by his
oncologist for the prostate cancer which he can not remember the
name of. He has no known drug allergies. In the ER he was found
to be 86% on room air and went up to 93% on Non-rebreather facemask
and breathing @ 30 times a minute. His blood pressure was 110/60.
His physical was significant for only a middle aged male in moderate
distress, breathing rapidly with use of accessory muscles not able
to complete full sentences. His lungs are clear, his cardiac exam
is significant for an RV heave and the rest his exam was essentially
normal. You take a look at the Chest X-ray and it is essentially
normal. You have an old chart and before you look at the new EKG
which is in your hands you see that his EKG in the old Chart from
about 2 months ago is totally Normal. Now you look at the new EKG
and this is what you see.
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Here for larger Image of EKG
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Case #33