A Partial Eclipse of the Heart

Author: Helen Salter / Editor: Steve Corry-Bass / Codes: Published: 03/11/2020

A 79-year-old female attends ED by ambulance after having 12 hours of central, pleuritic chest pain which radiated to the back across her shoulders.

The patient presents in the morning having had pain all night. The pain had not come on suddenly. She felt a bit short of breath when the paramedics arrived but is not breathless on arrival in ED. She takes warfarin for a previous PE. Three weeks previously she had been admitted for 7 days and had had a permanent pacemaker inserted.

She is in discomfort but not unwell. Observations are p78 regular, BP 150/90, T36.5, RR 20, sats 96% on air. On examination she has normal heart sounds, clear lung fields, she is slightly tender in the epigastrium and her calves are soft and non-tender. The pacemaker site is healing well and is non-tender. She is more comfortable sitting up in a chair.

Her ECG shows a broad complex paced rhythm.

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