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A 26 year old male presents with intermittent chest pain for 2 days. The pain is worse with exertion and does not radiate anywhere. He has an occasional cough but denies fever, chills or phlegm. He has no past medical history and takes no medications. His lung sounds are clear bilaterally. What does the EKG show and what is your diagnosis? Rate: 130 Rhythm: sinus tachycardia Axis: right axis deviation PR: 0.16 QRS: 0.04; Q wave in lead III ST: S wave in lead I; T inversions in III, AVF, V1-V5, flat T in V6 EKG Diagnosis: sinus tachycardia, RAD, S1Q3T3 pattern Clinical Diagnosis: Pulmonary embolism Treatment: Spiral CT chest or Angiography to confirm dx, thrombolytics if clinically warranted. Pt. must be anticoagulated- use LMWH initially, then Coumadin for 6mos to 1 year. A hematologic workup must be done to r/o a hypercoagulable state. |