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Wednesday, 18 June 2014

#ECGclass - Summer term Case 3


Welcome! 

If you are new to ECGclass, before we start, you may like to read this brief explanation of what it's all about: #ECGclass and how it works

Each 'term' is spilt into 5 cases launched a 2 weekly intervals.  

So here goes with the next case of this term!

Summer 3

A 49yr old man presents to you with a 6 month history of chest pain.

Sometimes this is triggered by exertion, sometimes at rest. 
It can be prolonged, often lasting several hours and on occasions, all weekend.
He considers himself fit and active, so he light-heartedly dismisses his symptoms, and works through his 'mild' discomfort, which is very localised in the left upper chest, without radiation. He has no arm pain, no dizziness, and no breathlessness. 
In fact, he has only presented under duress from his wife.

He is a non smoker, with no risk factors for IHD and not on any medication. 
On examination, as always, his BP is normal.  However, you do hear a systolic heart murmur at the left sternal edge.

You obtain an ECG below:


What are you thinking now?
What is your next step?

update

You press him a bit further to try and establish more detail about his history...
His symptoms are indeed predictably triggered by exertion on every occasion these days, and whilst he considers them mild enough to continue exercising through, they will usually settle within a minute or two of resting. On the other hand, he also gets episodes which are totally unprovoked and out of his control which can be prolonged at rest.  

He admits that his symptoms have become more progressive in nature (in terms of both frequency and severity) since their onset, over the past 6months. 

He insists he has no dizzy spells, syncope, no palpitations and  no family history of heart disease. He has alwasy made healthy lifestyle choices and has no risk factors for IHD.

Have these new revelations altered your suspicions, or swayed the urgency of your management?





DON'T FORGET!
Please use the hashtag #ECGclass if joining in the live and interactive conversation Twitter
and...If you want to ask the patient any questions, or request any further investigations this can  be done by the hashtag during the course of this evening. 


Alternatively, if referring to this blog at a later date, please leave comments below.
Thank you.



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Discussion/update later/see next blog post once available

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