EMS is called to the home of a 62-year-old female who complains of shortness of breath and epigastric discomfort.

On their arrival, they find the patient sitting on a chair in her living room, holding her hand to her chest while she talks with first responders. She is not pale, but appears diaphoretic, anxious, and has mildly laboured respirations.

Unfortunately not every patient that suffers a STEMI makes a complete recovery, even if treated with primary PCI. Patients that present late into their infarct have a higher risk of developing a complication.

Here are two cases that illustrate the spectrum of mechanical complications that can occur in the aftermath of an infarct.

Case 1

“Today, the vogue seems to be an irresistible urge to call VT supraventricular with aberration…” Marriott

A middle-aged male with a complex arrhythmia history contacts EMS after several hours of palpitations.

He has an implantable cardioverter defibrillator (ICD) but denies feeling any activations. He also denies any significant symptoms of dyspnea or discomfort.

A 55 year old man is brought in by EMS for altered mental status.

It is the middle of February and he was found sleeping outside. He smells of alcohol, is moaning on the gurney, and responds to painful stimuli.

Vital signs are assessed.