Shortness of breath, left arm pain


• Scene – 12-lead, vitals, IV, CBG

• En route – 12-lead, O2, vitals

• Hospital – unknown


• Response to treatment – conversion from rapid A-Fib to SR


Elliot Williams, Paramedic Woodburn Ambulance


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


• Shortness of breath

Differential Diagnosis

• Atrial fibrillation

• Myocardial infarction

• Pulmonary embolism

• COPD exacerbation

• Pneumonia

• Arrhythmia

Patient Workup History

• Patient states – She was working outside trimming trees when she became a little SOB and her L arm had a little pain. “I stay pretty busy doing things all day.”

• Caregiver states – She went to the hospital about two months ago was not diagnosed “with anything”

Physical Exam

• HTN, hyperglycemic, rapid A-Fib, slight SOB

• CBG – 216

• GCS – 15

• EKG – initial rapid A-fib, converted to NSR spontaneously

• BP – with rapid A-Fib, 174/80; after conversion, 150/60

• HR – initial 110-150; after 60

Editor’s Notes

Signs of myocardial infarction may be more subtle in women than in men. For example, mild shortness of breath, left arm pain and even pain in the jaw are known as signs of myocardial infarction in women. This patient’s complaints seem to have decreased over time since the 911 call. Close monitoring of vitals and signs/symptoms en route is a key part of EMS care.

-Dr. David Spiro

Suggested References

Atrial fibrillation


• Gender: Female

• Age: 79 years

• Height: Not Available


• Temperature: Not Available

• Blood Pressure: 174/80

• Heart Rate: 110-150

• Respiratory Rate: 16

• Pulse Oximetry: 97% RA

Signs and Symptoms

Shortness of breath, arm pain

History Medical

• PMH: Hypertension; mild dementia

• Allergies: None

• Dispatch info: SOB, L arm pain


• Lives with spouse, well kept home. Pt works doing chores inside and out; stays busy.


• ASA, lisinopril, donepezil, atenolol; prednisone started a week ago.

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