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78 year old male ECG with mild chest pain since 4 days
Reading File
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Finding Sources
Searching PubMed
"acute coronary syndrome" AND electrocardiography
Searching the Web
2025 acute chest pain ECG serial ECG troponin guideline ACC AHA
Reading File
Reading Web Page
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309
This should be treated as possible acute coronary syndrome and assessed in an emergency department now. A 78-year-old with chest pain for 4 days needs urgent clinical evaluation even if the pain is mild.
From these photographed ECG strips, limited by image quality and nonstandard recording display:
- Regular sinus rhythm, about 71 bpm
- Printed intervals: PR 144 ms, QRS 108 ms, QTc 396 ms
- Marked left axis deviation (printed QRS axis about -71°), compatible with a left anterior fascicular block
- I cannot reliably confirm or exclude subtle ST-segment ischemic changes from these photos.
- I do not see a definite diagnostic contiguous ST-elevation STEMI pattern on the visible leads, but that does not rule out NSTEMI, unstable angina, posterior ischemia, or an evolving infarction.
A single ECG has limited sensitivity for acute MI, especially after several days of symptoms; serial ECGs and troponin testing are needed. Rosen's Emergency Medicine notes that a single ECG can miss AMI and that serial ECG assessment improves detection in ongoing or recurrent chest pain - ROSEN's Emergency Medicine Concepts and Clinical Practice, p. 1013. The current ACC/AHA ACS guideline likewise supports repeat ECGs based on symptoms and clinical change.
Action now
- Go to an emergency department or call local emergency services. Do not drive himself.
- Obtain repeat properly placed 12-lead ECGs, serial high-sensitivity troponins, vital signs, clinical examination, and echocardiography if indicated.
- Seek immediate ambulance help if pain is ongoing/worsening or there is breathlessness, sweating, nausea, fainting, palpitations, or confusion.
- Do not rely on this ECG photograph or wait for outpatient testing. Do not take aspirin unless a clinician/emergency dispatcher advises it and there is no allergy, active bleeding, or prior instruction to avoid it.
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