Acute onset chest pain with history of myocardial infarction


• Scene – O2, vitals

• En Route – vitals, IV, cardiac monitor, 162mg ASA.

• Hospital – not known


• Response to treatment – no change

• Disposition – pt transported to OHSU code 3 without change


Eric Boyd, Paramedic Woodburn Ambulance


David Tauber, EMT Editorial Board

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Chest pain
• Shortness of breath

Differential Diagnosis

• MI • LVAD malfunction

• Arrhythmia

• Pneumonia

• Pulmonary embolus

• Congestive heart failure

Patient Workup History

• Patient states – sudden onset of sharp left-sided chest pain with some radiation to left arm.

• Pt states – pain is the same as when he had his last MI, but worse this time.

• Pt states – he took 162mg of ASA with onset of pain.

• Pt states – he has regular appointments for his LVAD check-up, and at the last appt., everything was normal.

• Pt denies any recent trauma

Physical Exam

• Bilateral breath sounds bilateral and equal.

• GCS – 15

• EKG – Sinus tach

Editor’s Notes

Obtaining history that the patient’s chest pain felt similar to his last myocardial infarction is important.

-Dr. David Spiro

Suggested References

Angina Pectoris


• Gender: Male

• Age: 66 years

• Height: Not Available


• Temperature: Not Available

• Blood Pressure: Not Available

• Heart Rate: 104

• Respiratory Rate: 20

• Pulse Oximetry: 100% RA

Signs and Symptoms

Radiating, L-sided chest pain; shortness of breath.

History Medical

• PMH: Myocardial infarction (MI), type-1 diabetes, hypertension (HTN).

• Allergies: None

• Dispatch info: Chest pain; shortness of breath (SOB); LVAD patient.


• Lives at home with wife

• No self reported tobacco and alcohol use.

• Pt states regular medical exams.


• ASA 162 mg

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