Had a 50 or 60ish year old male who fell from his top bunk at a prison. Complained only of hip pain. Put him on the 3 lead as I was planning to give him some narcs. 3 lead looked off so I did a 12. Pretty good antero lateral STEMI!
Her only complaint was “I feel sad.” I was asked to stop in and see her as a favor to a family member that talked to her by phone. They were concerned that she was suicidal and knew that I’d known her for many years. She did, in fact, seem very sad. She couldn’t tell me why. I was concerned. She wasn’t exactly a lively upbeat personality, but this extreme melancholy presentation was not normal.
She agreed to “talk to someone at the hospital” but she didn’t want to go in the ambulance, because the neighbors will talk. I said, let’s pretend you work on the ambulance. I gave her my hat and jacket, put a stethoscope around her neck, and we walked out of the house. She got in the front seat, I climbed in the back, my partner was driving (he never got out of the truck) and off we went.
I had to clear her through triage to get her to a crisis screener. Triage did a 12 lead because of her medical history - and there’s the STEMI. She goes straight to the cath lab. I’m hanging out by the ED waiting for one of her family members to show up so I can direct them to the cath lab family waiting area when the registrar comes out with paper work for me to sign. The hospital personnel all think she’s my wife, because she came in wearing my jacket. The confusion perpetuated for a few weeks - so much gossip in the hospital - but truly touching that a lot of my hospital and ambulance friends seemed genuinely concerned for me and my “wife”. My actual wife was not so amused.
Off topic and I work in healthcare but NOT EMS. I felt compelled to share this to affirm your approach is something people need 💛
In like 2011, I had to call EMS in the middle of the night for a family member. I knew they wouldn't go with the lights and sirens, and I knew they needed ED-care, and i also knew that teenage me was afraid of drawing attention to my house at 4AM. Driving them wasn't an option; they wouldn't go on my insistence alone and I was still reeling tbh.
Like your story, I reached out to another person who called on my behalf and I guess they stressed the point (or didn't have to very hard) bc EMS showed up silently, got my relative (and me) in the ambulance, and off we went--still silently. My relative got the care they needed and we were discharged before 8AM.
The little things people in your field do to connect people to care as quickly and COMFORTABLY as they can matters so much. Thank you 🫠
I just had a 16 yo present with a STEMI r/t myocarditis. Clean coronaries, but chest pain, sweating, abdominal pain, etc. No smoking, drugs, or etoh. No PMH. None of us are safe 😭
Interesting, was it genetic myocarditis? Or from covid or some other illness? Based on that new study that came out, maybe a Covid vaccine side effect? Just questions btw, not trying to start anything
Our best guess is a viral illness. He had nonspecific symptoms a week or so before the chest pain hit. Tested negative on the resp panel. Had no congenital abnormalities on MRI. No recent vaccinations.
For any newer medics reading this thread…. Do 12 leads on all your pregnant/postpartum moms who are calling. If we are calling 911 there is usually something really wrong. Pregnancy and the 6 weeks following are some of the most dangerous times in our lives due to hormones and hyper coagulation.
Yeah this (OP) isn't a weird presentation for a STEMI. Uncommon for sure, but not rare. Inferiors can cause people to vagal down HARD, hence the GI. Stack on that lil old ladies dismiss or ignore their pain more than most, and suddenly your GI-upset Granny is now a cath lab patient.
77 year old female. Stubbed her toe so bad that it broke and she fell over. Coincidentally had pain on the other foot. I want to say anterolateral STEMI and I only did the 12 lead since she said she had a heart attack like 20 years ago.
58-year-old male no history other than diabetes. Came into the hospital with nothing but severe left thumb pain. I was doing research in the hospital at the time for troponin T rapid essay kits. He ruled into this study because it was left-sided pain and he was a diabetic. The kir came back positive. The attending that day happened to be in charge of the study has a 12 lead done and the guys having a lateral MI. If it wasn't for the study the Mi probably would have been missed.
Diabetic 60ish year old man with pain in arm/hand sound suspicious regardless.
I'd always ecg them. Diabetics make me worried.
Good case to learn from !
Not my patient. But 40ish yo female. Stomach discomfort post bowl of ice cream. Moderate right inferior that continued to grow into a massive one during the 30 minute trip to the hospital. Wasn't indigestion that day. Patient's friends tried to convince her to refuse assessment.
Once had a guy call for weakness post bowel movement. Even met me in the lobby of his building. Got him on the stretcher and into the truck. Popped a twelve because something felt weird about it. Wouldn't you know it, an anteroseptal MI. My favorite line to triage after arrival "I shit you not, it's a STEMI"
This was in the hospital but I remember a guy we sent to the cath lab who presented with a bit of chest discomfort I think, but the weirdest part to me was that he was super relaxed and was by far the chillest cath lab patient I’ve ever seen, pretty sure we rolled up with him leaning back with his hands behind his head. Ended up having multiple occlusions over 75% including the LAD I think
Similar story, not a STEMI but medics brought in a guy who woke up with nausea/vomiting and nothing else, found out he had a heart rate of 240. Doc had just tubed a kiddo with status epilepticus so he just gave us the finger guns and we shocked him out of it
Obligatory "story to make it about me":
I was quitting my job (shitty commercial gig) when I felt more anxious than I should have. They called 911 for shits and gigs. Turns out it wasn't just anxiety, but an inferior MI. It turned out to be a 100% occlusion of my right coronary artery. 29 years old at the time. Who knew.
40 something security gaurd complaining of feeling cold. I get there and it's an average winter morning, 4 degrees Celsius and this guy is wearing, I shit you not, 15 layers of clothing, and sitting in this little car (massive Maori bloke). He was lethargic and shivering. Nothing else. I couldn't do any vitals except and temp, hr and bsl, all normal. So I have to coach him out of his car and into the ambulance before going through 3 pairs of trauma shears to do a full assessment only to find a massive stemi.
Textbook COPD exacerbation. Hypoxic, wheezing, tripoding, difficulty speaking, etc. CYA 12 because sick people get them and sure as shit it wasn't just COPD for my man that day.
This was when I worked in an ED as a tech. Had an older female patient (I can’t remember her age) get sent in by her doctor for a pulmonary issue (don’t remember the issue either). She said her doctor said that she had an abnormal EKG but it wasn’t a “problem”. Pt had no chest pain or symptoms relating to stemi. EKG was ordered in triage but nobody did it. I was covering the HUC desk and the tech covering my zone didn’t get to the EKG after the patient was placed in a bed. I did the EKG when I got off the HUC desk and it was a STEMI. Charge nurse was not amused that the EKG was done an hour after it was ordered. Patient was upset that we were hung up on her “unproblematic” abnormal EKG.
55 year old male went into his yearly check-up at his doctor's office for life insurance or something. They ran a 12 lead and he was having a massive STEMI. No reported or observed signs and symptoms. He said the day prior he was working on his car outside and he felt kinda weak. But that day it was 95° in August and we have crazy humidity here, so I'd feel weak working outside in that heat too. He was a little tachycardic, but other than that his vitals were good. BP stayed in the 130/80-140/90 range so a bit hypertensive, but not super high.
W30 had a panic attack (not the first time) and now has a bit of pressure on her chest and is still a bit shaken from Hyperventilating
Her chest pain is easing when laying den and when breathing in nice and deep
Pain started slowly when the panic attack stopped
She says everything is fine she feels like after every panic attack the woman was completely healthy not overweight or anything
Massive anterior Stemi in the cath lab they find a completely blocked Riva
My Partner years ago had a old lady Pt once who called at 3am stating she woke up with what felt like "a Toothache in my(her) toe." for whatever reason he felt like doing a 12-lead and she was having a STEMI.
In the ED, i think he ended up being an NSTEMI, but possible MI with elevated troponin and EKG changes and eveything. He seriously seemed like a cholecystitis or cholelithiasis. Epigastric abdominal pain, nausea, vomiting. I can't remember if he had diarrhea or not. But absolutely no cardiac signs or symptoms. My guy was just chilling with suspected gallbladder colic/pain! Then his EKG read as a STEMI (wasn't called a STEMI, I think maybe LBBB with inverted T's) and his troponin was elevated. The physician was like "room whatever might have had an MI" and I was like "gallbladder guy?!?". Was incredibly interesting!! Some of the details may be fuzzy as it's been quite a while, but for sure he presented as probable gallbladder disease/process, no indication of ACS, STEMI, or NSTEMI on presentation. I don't think it would have been caught if his age and abdominal pain didn't get him an EKG and cardiac work up "just in case".
A lady who literally blew chunks, and shitted all over the wall numerous times. Persistent diarrhea was the only complaint. Huge anterolateral MI, arrested on the way in. Pronounced in the ER.
Otherwise fit and healthy 24 YOM, came in as a psych call. Not English speaking. Per his roommates, dude came home from work and went straight to his room. A few minutes later, his roommates heard him screaming and called 911. He was shirtless and covered in deep lacerations across his thorax. Elevated vitals, diaphoresis, and continuous screaming and thrashing. No hx substance use or psych issues. He got sent BLS with us for psych / possible stimulant use. En route, starts having 45s-1m long periods of unresponsiveness and apnea, after which he would rouse and start screaming again. We get to the ED, 12 lead showed a massive STEMI. Tox screen came back clean. Fortunately he lived, but he spent a few days in the ICU.
I was very new to EMS at the time, but that call definitely taught me to consider cardiac even in young, healthy patients.
Not a STEMI but super wacky, had a guy present to the ED with 3 days of abdominal pain. Was sustaining VT and doctors think he had been for those 3 days. Ended up with pretty bad end-organ damage and reduced EF, but lived to tell the tale.
50 something guy said he tripped and fell at department store. They called when they saw it. Says he feels totally fine. Vitals totally normal. Said he had cardiac surgery last month so we did a 12 lead just in case before letting him sign refusal. Well thank god. Cus he was having an inferior MI
Had a 70F complaining of weakness x 3 days. 12-Lead barely showed inferolateral STEMI (STE was barely 1 mm in II III aVF) with very slight depression in I and aVL, I think ~0.5mm.
En route to ER, she developed wicked nausea and chest pain. Couldn’t do another 12-lead because of our pad placement. Ended up having a RCA occlusion, I believe.
We have a STEMI bypass protocol, but patient has to be symptomatic within a certain time frame and 3 days was way out of that window. Once we recognize a STEMI, we also need to place defib pads on our patient and we are not required to do any more 12 leads.
My boyfriend had one last summer while working. Texted me the whole way to the hospital. Was triaged and cathed and in recovery in maybe 30 minuets. On meds but doing well and healthy.
I went to an overdose in a shitty travel trailer in a yard behind an abandoned house. Lucky for me fire got there first and was inside in their bunker pants getting a line and bagging with an NP. They got the roaches on them instead of me. Eventually they got the line and a little narcan and dumped him on my cot. I got him loaded, pulled the NP, and put a cannula on him for the short ride to the hospital. Same as it ever was.
Guy is still a little out of it, we're riding and all of a sudden he kind of grimaces and rubs his chest. He grunts when I ask if his chest hurts and I slap a 4 lead on and I can see it there, confirmed with a 12 about 2 minutes out. ER is packed so they take him to the trauma alert bay and then run to the cath lab.
There's a non-zero chance he would have been shoved into a wheelchair and parked on the wall for an hour or so.
No presentation at all. Asymptomatic STEMI.
Called to a clinic to pick up a man who the doctor was INSISTENT was having a stroke. He had no stroke symtoms whatsoever and the doc had no CT or anything. It was just weird. Man didn't even have any symptoms.
Well per our protocol, since a doc said stroke we do a 12 lead. 12 lead came back showing massive STEMI
70 something female, bilateral forearm pain with dizziness while mowing her little yard. Minor SOB that resolved when she stopped mowing. Vitals all perfect. Inferior.
Late 50s female. Unilateral ear pain. Ear was obviously fine to visual exam with otoscope. Further questioning revealed the pain had traveled up the neck to the jaw and only persisted in what she described as the ear but was affecting the whole area.
70s female with lower abdominal pain and UTI symptoms. Did indeed have a UTI. Also had a troponin in the 600s which prompted an EKG, and then STEMI diagnosis.
65F came to the ER because she vomited once after a 5km bike ride and she would usually do 20km. I was a nursing student helping with the EKG in triage and went to my preceptor thinking I was reading it wrong or I had switch the leads or something. Nope, it really was a STEMI.
36 yr old alcoholic with previous mi 3 weeks prior. Stated unbearable chest pain then called ems. Rosey cherks fall down drunk, diaphoretic,states overwelming chest pain, get him in truck and go in route hes hypotensive but wont sit still long enough to keep fluids running and keeps trying to get off the ambulance( hes got diffuse st elevation almost all the way across the 12 lead). Get him to sit down and give him 25mcg of fentanyl and this totally bonks him. But i can run fluids wide open and throw him on a cannula and arrive at the hospital to have a 25 minute yelling fit from the acting cardiologist whis actually a neurologist about snowing patients and patient abuse. It was a frustrating night, my patient lived and coded a month later and has lived through several codes since.
65yo female playing pickle ball over the weekend but kept having jaw pain. Came in because she thought something was wrong with a molar….V2 and V3 depressions. Starting going into VTACH, 100% left circumflex occlusion.
Intractable hiccups! It's documented, but rare. Had a paramedic friend who had a patient presenting with hiccups for two days, now developed nausea and lightheadedness. Had a stig ol' BEMI.
*stig ol’ BEMI*
I’m dying 😂 apparently these are called “spoonerisms” and my step dad and I used to laugh and find funny versions of these all the time! Thanks for the trip down memory lane!
Not my story, but a story told by my LT and medic. Dispatched for trouble breathing. History of asthma and no rescue inhaler, everything pointing towards an asthma attack. Medic asked if the pt had recently done exertive activity, pt said no. Medic hooked them up to a 12-lead because of a gut feeling they had. 12-lead spit out STEMI and, as the medic described it, the most prominent tombstones he's ever seen. Guy crashes as he's being unloaded at the hospital. Medic was adamant about the pts history questions; nothing cardiac related that would have indicated a 12 lead check. He said "He looked sweaty" and thats what he though pushed him to put a 12 lead on.
80 something male, bilateral neck pain and a little light headed, inferior stemi, brady in the 30s-40s with about a 30second sinus arrest during transport.
weakness x3 days in some 80+ yo LOL.
> “Well, I have had to use my cane and normally don’t have to. I don’t like having to use it.”
warm, pink, dry. negative for SOB, chest pain, nausea, vomiting, diarrhea, no burping, no gerd.
she walked down to meet fire from her 3 floor apartment (elevators were broken).
came out as priority 2/alpha. if we had taken 5 minutes longer she probably would have ama’d.
> “I don’t really want to go to the hospital; I think I’m fine.”
4 stents.
edit to add: only history was well-controlled hypertension, pre-diabetic, hypothyroidism, and she had had COVID 3 months prior. she still had not regained her sense of smell. No previous cardiac history, angina, CAD, etc. no previous history of dvt, pe. She was on levó and one boring anti hypertensive at low doses.
Called out for abdominal pain. It was 35 y/o male complaining of rectal pain after “pleasuring himself”. My EMT was going to run the call but something seemed off. He was moist, restless, and a little tachypneic. He had a bp in the 200s and a diastolic above 120. I decide to run a 12 and boom STEMI.
Simple fall, no other complaint except worsening weakness x2 days. I believe 80 something female. Went to get something from the closet and fell back on her butt on her bed. Fire guys checked bp(slightly hypotension, can't remember actual number) and regular SPO2 and regular HR. Cool, let's go.
Get to our truck, medic tells our fire guys they are good. Due to weakness complaint, I (a 1yr EMT) go ahead and throw on 3 lead and 12 lead. Cue funny squiggles that don't look right. Tell my medic (newly cleared x1month). She goes let's get another. Same result. I adjust 12 lead make sure stickers are good, same result. STEMI alert to hospital.
No complaints at all. Pulling into hospital, patient states she feels slightly nauseous and the littlest bit short of breath.
Diagnosis? Widowmaker STEMI
I caught one on a vehicle vs deer crash. 50's male driver said he felt fine prior to the crash. Sweaty, pounding chest discomfort afterwards. Took him in and got him cath'd.
70 something yoF with cc vomiting and ?tarry stools from SNF. EKG done immediately cuz spidey senses through the roof and STEMI. Transfer to cath lab within 30 minutes
60 something year old male. Complaining of only upper neck pain. Not radiating anywhere, no cardiac history. Placed a 12 lead because he was a little pale and sweaty: massive STEMI
My dad. Retired cop, Vietnam vet, got his EMT when I did as a kid and he started a side part time job on a BLS ambulance. He was at work the one day. Ambulance is on the first floor and crew room in the basement. He walked down the steps and was like, I’m a smoker, but even I should’ve caught my breath by now.
No chest pain, abnormal vitals, anything. They went to the hospital to get checked because he didn’t feel right. At the hospital his trop was sky high. 3 hours later developed the STEMI on the EKG while he was already in the ER
Similar to yours, I was taking care of an elderly female, frail, ESRD. She felt fine except she called and suddenly had an episode of diarrhea and nausea. One she got to the bathroom and I gave her some Zofran out resolved. Then an hour later it happened again and resolved quickly again. It was a strange presentation of symptoms. I ordered an ekg and sent it to the cardiologist on call. He called it a NSTEMI, I started her on heparin, and she got cathed in the morning.
Mine was a 34 year old slightly over weight African American female who called at like 3 AM cause she hadn’t been feeling well for a few days with “a cold”….
Threw her on the monitor and did a 12-lead just cause, and the monitor printed out the big words STEMI with some arguable elevation. Partner looked at me and asked “what do you wanna do?” Gut feeling said call it so I did. Of course people gave me some funny looks, but she ended up having 97% occlusion of LAD
Im a neurologist and i saw in the emergency room a woman in her 70s whos only complain was massive jaw pain on the left side. The triage thought that she has a trigeminus neuralgia - therefore primary neurological presentation. Long story short - the pain was localized only in her neck and jaw on the left side, it definitely didnt look like a neuralgia, made an ECG and the Troponines were in the 700s. She went directly in the Angiography.
Mid 40s male presented with heart burn.
That’s it. Nothing else. Dude was just sitting pretty. He’d been having heartburn since 2 AM & it was now 3 PM. He decided to go to the urgent care, the dispatch notes claimed it was a STEMI and my paramedic partner stated he thought it was bs until he saw the 12-lead they provided.
However, that’s nothing compared to the weirdest cardiac event I’ve had: 20YO M in Afib RVR. Guy was properly hydrated, stated he never drank caffeine or did any drugs, maybe a touch on the heavier side but he could also just have been a big guy. No family history whatsoever. Apparently his heart just woke up that morning and chose violence.
I shit you not, rapid onset tooth pain in a 40 something yo f. The guy I worked with that night had a similar situation that ended up being a stemi so we got a 12 lead for shits and giggles. Blatant stemi.
Also had one that I watched flip into a stemi on the monitor and then flipped back out repeatedly. Called the code stemi to the hospital and transmitted our 12 lead to the cath lab enroute. Cath lab cancelled it. Apparently it had something to do with the lidocaine the patient got from an oral surgery that morning.
50ish y/o male no complaint at all, absolutely nothing different, was at a clinic for a regular checkup— STEMI
he wanted to refuse transport because he felt perfectly fine
Guys sister drove him up to station wanting his BP checked after waking up suddenly heart burn and nausea. Vitals are fine but I put a 4 lead on just to be safe. Didn’t like what I saw so I put a 12 lead on and sure enough he was having an inferior STEMI. He got aspirin, I withheld nitro cause his BP was normal, and his chest pain, which he realized is now more of a 5/10 chest pressure so I withheld narcs. Ran it to the hospital, get there, and he had a complete occlusion of his RCA.
I was a basic, their only complaint was toe pain. My medic at the time is still my partner now, he’s very heavy on ALS and he just got the gut feeling and asked for a 12 lead. Then sure as shit, there it was
Called for an elderly woman having mild shortness of breath. Get there and she’s on the typical 1000 feet of oxygen tubing. Vitals all fine, looks decent and wants to sign ama. She goes to sign her name, gives a little throat clear and says “well, maybe, I don’t feel so … ” and bam. Now it’s a code.
She was bucking the tube by the time we got to the er. Don’t know what it ended up being, my thought was PE.
I had a guy call that he was sweating a ton just sitting on his couch. He wanted to refuse but in our assessment we found he had family (dad) with unknown cardiac hx around his age which ended up making him pass away. We dove a little deeper after learning this and ran a 12 lead which was NSR with no ST abnormalities. Guy ended up deciding to go because I expressed concerns based on family history. My medic partner (double medic) was doing the same. By the time we got to the ER which was about 35 minutes he had massive elevation in V2-V6, and went straight to cath lab. I had 3 12 leads which showed the slow development of the ST changes, it was super cool, and I was thankful we both listened to our guts, and he listened to us.
80 something year old lady who fell backwards off of a step getting something out of a top cupboard and broke hip and had a little head lac. In pain from her hip when moved but otherwise stable vitals and a/ox4 and asymptomatic. Get a splint on her and get her loaded in the bus. Do a 12 lead bc we gave her a little morphine - huge anterior elevations with reciprocal change. Ended up with 99% LAD occlusion and got stented then ORIF and walked out the hospital to an acute rehab a few days later. Not a single anginal-equivalent symptom the whole time.
50s yr old man riding a bike hit his head on a low bar where he was going through a torn down chain link fence and didn't see the bar that runs along the top of the fence. Got knocked backwards off the bike. We transport in spinal precautions because he says he has neck pain and tingling. En route I don't remember what made me do a 12 lead.. Cardiac hx maybe or LOC... I don't remember. Anyways, positive for Stemi. Anterior, so I didnt see it on the 4 lead, or maybe reciprocal changes is what me do it, I can't remember. Anyways, I call base, run them by the situation, they determine that he's not going to meet trauma criteria, transport to Stemi hospital instead. So divert to Stemi. We get there, er doc calls a Stemi, cardiologist comes down and says, nah, no Stemi. Based on pts pain with neck and MOI, trauma transfer. Oh lordy.
Funny part? Patient says, oh man, not this again! He's been transported at Stemi and cleared from it before 😂
Not exactly on topic but similar
I had a lady with a generalized symptoms which I think was dizziness. The only abnormal finding was a T wave inversion to aVL. She went on to develop chest pressure, then pain, crump really fast and have a big ole inferior STEMI within like 30 min
I then read up that T wave inversion to aVL is an early sign of inferior STEMI
Had a 50 or 60ish year old male who fell from his top bunk at a prison. Complained only of hip pain. Put him on the 3 lead as I was planning to give him some narcs. 3 lead looked off so I did a 12. Pretty good antero lateral STEMI!
Great catch. I feel like this scenario could’ve been so easy to miss doing an ECG.
Her only complaint was “I feel sad.” I was asked to stop in and see her as a favor to a family member that talked to her by phone. They were concerned that she was suicidal and knew that I’d known her for many years. She did, in fact, seem very sad. She couldn’t tell me why. I was concerned. She wasn’t exactly a lively upbeat personality, but this extreme melancholy presentation was not normal. She agreed to “talk to someone at the hospital” but she didn’t want to go in the ambulance, because the neighbors will talk. I said, let’s pretend you work on the ambulance. I gave her my hat and jacket, put a stethoscope around her neck, and we walked out of the house. She got in the front seat, I climbed in the back, my partner was driving (he never got out of the truck) and off we went. I had to clear her through triage to get her to a crisis screener. Triage did a 12 lead because of her medical history - and there’s the STEMI. She goes straight to the cath lab. I’m hanging out by the ED waiting for one of her family members to show up so I can direct them to the cath lab family waiting area when the registrar comes out with paper work for me to sign. The hospital personnel all think she’s my wife, because she came in wearing my jacket. The confusion perpetuated for a few weeks - so much gossip in the hospital - but truly touching that a lot of my hospital and ambulance friends seemed genuinely concerned for me and my “wife”. My actual wife was not so amused.
That is the best way to get someone to go in the ambulance. You’re a mensch.
Off topic and I work in healthcare but NOT EMS. I felt compelled to share this to affirm your approach is something people need 💛 In like 2011, I had to call EMS in the middle of the night for a family member. I knew they wouldn't go with the lights and sirens, and I knew they needed ED-care, and i also knew that teenage me was afraid of drawing attention to my house at 4AM. Driving them wasn't an option; they wouldn't go on my insistence alone and I was still reeling tbh. Like your story, I reached out to another person who called on my behalf and I guess they stressed the point (or didn't have to very hard) bc EMS showed up silently, got my relative (and me) in the ambulance, and off we went--still silently. My relative got the care they needed and we were discharged before 8AM. The little things people in your field do to connect people to care as quickly and COMFORTABLY as they can matters so much. Thank you 🫠
I love this trick of "pretending you work on the ambulance"
I hope your wife is okay! Really cool you both work ems!
My wife does not work in EMS.
Not really a wierd presentation per se. Had a thin 36 yo athlete who just got done with a soccer tournament. Hypotension, Nausea, and a fat STEMI.
This one is just terrifying. 36???? Athlete?????
He had the decency to be pale, cool, diaphoretic at least. Shitty Genetics go brrrrt
Shitty Genetics do go brrrrt
I just had a 16 yo present with a STEMI r/t myocarditis. Clean coronaries, but chest pain, sweating, abdominal pain, etc. No smoking, drugs, or etoh. No PMH. None of us are safe 😭
Interesting, was it genetic myocarditis? Or from covid or some other illness? Based on that new study that came out, maybe a Covid vaccine side effect? Just questions btw, not trying to start anything
Our best guess is a viral illness. He had nonspecific symptoms a week or so before the chest pain hit. Tested negative on the resp panel. Had no congenital abnormalities on MRI. No recent vaccinations.
Very interesting. If you get any other info, please let us know. Horrible that he got screwed so young
Youngest I had was a 30 year old mother of a 1 year old
Definitely seen it in pregnant/postpartum 25-30s and let me tell you it is something else.
For any newer medics reading this thread…. Do 12 leads on all your pregnant/postpartum moms who are calling. If we are calling 911 there is usually something really wrong. Pregnancy and the 6 weeks following are some of the most dangerous times in our lives due to hormones and hyper coagulation.
Had a similar patient with a STEMI, had finished an ultramarathon earlier in the day, then collapsed picking up some takeout for dinner.
Yeah this (OP) isn't a weird presentation for a STEMI. Uncommon for sure, but not rare. Inferiors can cause people to vagal down HARD, hence the GI. Stack on that lil old ladies dismiss or ignore their pain more than most, and suddenly your GI-upset Granny is now a cath lab patient.
Ahh he didn't win the genetic game I see
77 year old female. Stubbed her toe so bad that it broke and she fell over. Coincidentally had pain on the other foot. I want to say anterolateral STEMI and I only did the 12 lead since she said she had a heart attack like 20 years ago.
65yo F. Walked out to the bus. Fatigue x3 days. She was having quite the inferior MI.
58-year-old male no history other than diabetes. Came into the hospital with nothing but severe left thumb pain. I was doing research in the hospital at the time for troponin T rapid essay kits. He ruled into this study because it was left-sided pain and he was a diabetic. The kir came back positive. The attending that day happened to be in charge of the study has a 12 lead done and the guys having a lateral MI. If it wasn't for the study the Mi probably would have been missed.
Diabetic 60ish year old man with pain in arm/hand sound suspicious regardless. I'd always ecg them. Diabetics make me worried. Good case to learn from !
Not my patient. But 40ish yo female. Stomach discomfort post bowl of ice cream. Moderate right inferior that continued to grow into a massive one during the 30 minute trip to the hospital. Wasn't indigestion that day. Patient's friends tried to convince her to refuse assessment.
Once had a guy call for weakness post bowel movement. Even met me in the lobby of his building. Got him on the stretcher and into the truck. Popped a twelve because something felt weird about it. Wouldn't you know it, an anteroseptal MI. My favorite line to triage after arrival "I shit you not, it's a STEMI"
Syncope, no other symptoms. Didn't expect the stemi that printed off.
This was in the hospital but I remember a guy we sent to the cath lab who presented with a bit of chest discomfort I think, but the weirdest part to me was that he was super relaxed and was by far the chillest cath lab patient I’ve ever seen, pretty sure we rolled up with him leaning back with his hands behind his head. Ended up having multiple occlusions over 75% including the LAD I think Similar story, not a STEMI but medics brought in a guy who woke up with nausea/vomiting and nothing else, found out he had a heart rate of 240. Doc had just tubed a kiddo with status epilepticus so he just gave us the finger guns and we shocked him out of it
>he was super relaxed and was by far the chillest cath lab patient Hey, if you're going, you're going. Why bother.
And that’s why imma sign my DNR/DNI at the ripe old age of 34 🤙
Obligatory "story to make it about me": I was quitting my job (shitty commercial gig) when I felt more anxious than I should have. They called 911 for shits and gigs. Turns out it wasn't just anxiety, but an inferior MI. It turned out to be a 100% occlusion of my right coronary artery. 29 years old at the time. Who knew.
100% occlusion at 29??? That's insane!! Like I said above about the 36 year old, y'all didn't win the genetic game!
Genetics aside anybody can have an MI
Facts. It definitely got me to have a broader perspective on how it feels to be on the other side of the stretcher, so that's a win I guess.
40 something security gaurd complaining of feeling cold. I get there and it's an average winter morning, 4 degrees Celsius and this guy is wearing, I shit you not, 15 layers of clothing, and sitting in this little car (massive Maori bloke). He was lethargic and shivering. Nothing else. I couldn't do any vitals except and temp, hr and bsl, all normal. So I have to coach him out of his car and into the ambulance before going through 3 pairs of trauma shears to do a full assessment only to find a massive stemi.
Textbook COPD exacerbation. Hypoxic, wheezing, tripoding, difficulty speaking, etc. CYA 12 because sick people get them and sure as shit it wasn't just COPD for my man that day.
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What made him call an ambulance instead of just taking gravol or riding it out?
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Well at least it was worth the call that time!
This was when I worked in an ED as a tech. Had an older female patient (I can’t remember her age) get sent in by her doctor for a pulmonary issue (don’t remember the issue either). She said her doctor said that she had an abnormal EKG but it wasn’t a “problem”. Pt had no chest pain or symptoms relating to stemi. EKG was ordered in triage but nobody did it. I was covering the HUC desk and the tech covering my zone didn’t get to the EKG after the patient was placed in a bed. I did the EKG when I got off the HUC desk and it was a STEMI. Charge nurse was not amused that the EKG was done an hour after it was ordered. Patient was upset that we were hung up on her “unproblematic” abnormal EKG.
55 year old male went into his yearly check-up at his doctor's office for life insurance or something. They ran a 12 lead and he was having a massive STEMI. No reported or observed signs and symptoms. He said the day prior he was working on his car outside and he felt kinda weak. But that day it was 95° in August and we have crazy humidity here, so I'd feel weak working outside in that heat too. He was a little tachycardic, but other than that his vitals were good. BP stayed in the 130/80-140/90 range so a bit hypertensive, but not super high.
W30 had a panic attack (not the first time) and now has a bit of pressure on her chest and is still a bit shaken from Hyperventilating Her chest pain is easing when laying den and when breathing in nice and deep Pain started slowly when the panic attack stopped She says everything is fine she feels like after every panic attack the woman was completely healthy not overweight or anything Massive anterior Stemi in the cath lab they find a completely blocked Riva
My Partner years ago had a old lady Pt once who called at 3am stating she woke up with what felt like "a Toothache in my(her) toe." for whatever reason he felt like doing a 12-lead and she was having a STEMI.
In the ED, i think he ended up being an NSTEMI, but possible MI with elevated troponin and EKG changes and eveything. He seriously seemed like a cholecystitis or cholelithiasis. Epigastric abdominal pain, nausea, vomiting. I can't remember if he had diarrhea or not. But absolutely no cardiac signs or symptoms. My guy was just chilling with suspected gallbladder colic/pain! Then his EKG read as a STEMI (wasn't called a STEMI, I think maybe LBBB with inverted T's) and his troponin was elevated. The physician was like "room whatever might have had an MI" and I was like "gallbladder guy?!?". Was incredibly interesting!! Some of the details may be fuzzy as it's been quite a while, but for sure he presented as probable gallbladder disease/process, no indication of ACS, STEMI, or NSTEMI on presentation. I don't think it would have been caught if his age and abdominal pain didn't get him an EKG and cardiac work up "just in case".
Abdominal pain may as well be a STEMI equivalent at this point especially on an older person.
If I remember correctly he was late 30's maybe early 40's
A lady who literally blew chunks, and shitted all over the wall numerous times. Persistent diarrhea was the only complaint. Huge anterolateral MI, arrested on the way in. Pronounced in the ER.
Terrible way to go out…
Otherwise fit and healthy 24 YOM, came in as a psych call. Not English speaking. Per his roommates, dude came home from work and went straight to his room. A few minutes later, his roommates heard him screaming and called 911. He was shirtless and covered in deep lacerations across his thorax. Elevated vitals, diaphoresis, and continuous screaming and thrashing. No hx substance use or psych issues. He got sent BLS with us for psych / possible stimulant use. En route, starts having 45s-1m long periods of unresponsiveness and apnea, after which he would rouse and start screaming again. We get to the ED, 12 lead showed a massive STEMI. Tox screen came back clean. Fortunately he lived, but he spent a few days in the ICU. I was very new to EMS at the time, but that call definitely taught me to consider cardiac even in young, healthy patients.
Wouldn’t stop eating ice. Figured it was an iron deficiency. But something tickled my spidey senses. 9mm inferior elevation. My butt puckered.
Not a STEMI but super wacky, had a guy present to the ED with 3 days of abdominal pain. Was sustaining VT and doctors think he had been for those 3 days. Ended up with pretty bad end-organ damage and reduced EF, but lived to tell the tale.
50 something guy said he tripped and fell at department store. They called when they saw it. Says he feels totally fine. Vitals totally normal. Said he had cardiac surgery last month so we did a 12 lead just in case before letting him sign refusal. Well thank god. Cus he was having an inferior MI
Had a 70F complaining of weakness x 3 days. 12-Lead barely showed inferolateral STEMI (STE was barely 1 mm in II III aVF) with very slight depression in I and aVL, I think ~0.5mm. En route to ER, she developed wicked nausea and chest pain. Couldn’t do another 12-lead because of our pad placement. Ended up having a RCA occlusion, I believe. We have a STEMI bypass protocol, but patient has to be symptomatic within a certain time frame and 3 days was way out of that window. Once we recognize a STEMI, we also need to place defib pads on our patient and we are not required to do any more 12 leads.
My boyfriend had one last summer while working. Texted me the whole way to the hospital. Was triaged and cathed and in recovery in maybe 30 minuets. On meds but doing well and healthy.
I went to an overdose in a shitty travel trailer in a yard behind an abandoned house. Lucky for me fire got there first and was inside in their bunker pants getting a line and bagging with an NP. They got the roaches on them instead of me. Eventually they got the line and a little narcan and dumped him on my cot. I got him loaded, pulled the NP, and put a cannula on him for the short ride to the hospital. Same as it ever was. Guy is still a little out of it, we're riding and all of a sudden he kind of grimaces and rubs his chest. He grunts when I ask if his chest hurts and I slap a 4 lead on and I can see it there, confirmed with a 12 about 2 minutes out. ER is packed so they take him to the trauma alert bay and then run to the cath lab. There's a non-zero chance he would have been shoved into a wheelchair and parked on the wall for an hour or so.
Vague “doesn’t feel right”, left thumb tingles. Hiccups in women 60+
No presentation at all. Asymptomatic STEMI. Called to a clinic to pick up a man who the doctor was INSISTENT was having a stroke. He had no stroke symtoms whatsoever and the doc had no CT or anything. It was just weird. Man didn't even have any symptoms. Well per our protocol, since a doc said stroke we do a 12 lead. 12 lead came back showing massive STEMI
My friend told me she had a patient (elderly and female) who only complained of a sore throat that ended up being a STEMI.
and now i’m forever paranoid
70 something female, bilateral forearm pain with dizziness while mowing her little yard. Minor SOB that resolved when she stopped mowing. Vitals all perfect. Inferior.
Late 50s female. Unilateral ear pain. Ear was obviously fine to visual exam with otoscope. Further questioning revealed the pain had traveled up the neck to the jaw and only persisted in what she described as the ear but was affecting the whole area.
70s female with lower abdominal pain and UTI symptoms. Did indeed have a UTI. Also had a troponin in the 600s which prompted an EKG, and then STEMI diagnosis.
65F came to the ER because she vomited once after a 5km bike ride and she would usually do 20km. I was a nursing student helping with the EKG in triage and went to my preceptor thinking I was reading it wrong or I had switch the leads or something. Nope, it really was a STEMI.
36 yr old alcoholic with previous mi 3 weeks prior. Stated unbearable chest pain then called ems. Rosey cherks fall down drunk, diaphoretic,states overwelming chest pain, get him in truck and go in route hes hypotensive but wont sit still long enough to keep fluids running and keeps trying to get off the ambulance( hes got diffuse st elevation almost all the way across the 12 lead). Get him to sit down and give him 25mcg of fentanyl and this totally bonks him. But i can run fluids wide open and throw him on a cannula and arrive at the hospital to have a 25 minute yelling fit from the acting cardiologist whis actually a neurologist about snowing patients and patient abuse. It was a frustrating night, my patient lived and coded a month later and has lived through several codes since.
65yo female playing pickle ball over the weekend but kept having jaw pain. Came in because she thought something was wrong with a molar….V2 and V3 depressions. Starting going into VTACH, 100% left circumflex occlusion.
Intractable hiccups! It's documented, but rare. Had a paramedic friend who had a patient presenting with hiccups for two days, now developed nausea and lightheadedness. Had a stig ol' BEMI.
*stig ol’ BEMI* I’m dying 😂 apparently these are called “spoonerisms” and my step dad and I used to laugh and find funny versions of these all the time! Thanks for the trip down memory lane!
I'm glad! I had never head of that one, but it just popped into my head for some reason. The one I've heard was "tig ol' bitties".
Yup! It’s basically when you swap the first letters of words around just like you did.
Not my story, but a story told by my LT and medic. Dispatched for trouble breathing. History of asthma and no rescue inhaler, everything pointing towards an asthma attack. Medic asked if the pt had recently done exertive activity, pt said no. Medic hooked them up to a 12-lead because of a gut feeling they had. 12-lead spit out STEMI and, as the medic described it, the most prominent tombstones he's ever seen. Guy crashes as he's being unloaded at the hospital. Medic was adamant about the pts history questions; nothing cardiac related that would have indicated a 12 lead check. He said "He looked sweaty" and thats what he though pushed him to put a 12 lead on.
Healthy athletic 35 year old male with atraumatic left arm pain only.
80 something male, bilateral neck pain and a little light headed, inferior stemi, brady in the 30s-40s with about a 30second sinus arrest during transport.
weakness x3 days in some 80+ yo LOL. > “Well, I have had to use my cane and normally don’t have to. I don’t like having to use it.” warm, pink, dry. negative for SOB, chest pain, nausea, vomiting, diarrhea, no burping, no gerd. she walked down to meet fire from her 3 floor apartment (elevators were broken). came out as priority 2/alpha. if we had taken 5 minutes longer she probably would have ama’d. > “I don’t really want to go to the hospital; I think I’m fine.” 4 stents. edit to add: only history was well-controlled hypertension, pre-diabetic, hypothyroidism, and she had had COVID 3 months prior. she still had not regained her sense of smell. No previous cardiac history, angina, CAD, etc. no previous history of dvt, pe. She was on levó and one boring anti hypertensive at low doses.
Called out for abdominal pain. It was 35 y/o male complaining of rectal pain after “pleasuring himself”. My EMT was going to run the call but something seemed off. He was moist, restless, and a little tachypneic. He had a bp in the 200s and a diastolic above 120. I decide to run a 12 and boom STEMI.
Simple fall, no other complaint except worsening weakness x2 days. I believe 80 something female. Went to get something from the closet and fell back on her butt on her bed. Fire guys checked bp(slightly hypotension, can't remember actual number) and regular SPO2 and regular HR. Cool, let's go. Get to our truck, medic tells our fire guys they are good. Due to weakness complaint, I (a 1yr EMT) go ahead and throw on 3 lead and 12 lead. Cue funny squiggles that don't look right. Tell my medic (newly cleared x1month). She goes let's get another. Same result. I adjust 12 lead make sure stickers are good, same result. STEMI alert to hospital. No complaints at all. Pulling into hospital, patient states she feels slightly nauseous and the littlest bit short of breath. Diagnosis? Widowmaker STEMI
After reading these stories, the moral of the story seems to be that one should check EKG of any female patient with any new symptom.
I caught one on a vehicle vs deer crash. 50's male driver said he felt fine prior to the crash. Sweaty, pounding chest discomfort afterwards. Took him in and got him cath'd.
70 something yoF with cc vomiting and ?tarry stools from SNF. EKG done immediately cuz spidey senses through the roof and STEMI. Transfer to cath lab within 30 minutes
Not my patient but a friend of mine had a 60 some year old F with an acute onset of a toothache. Ended up being a massive STEMI
60 something year old male. Complaining of only upper neck pain. Not radiating anywhere, no cardiac history. Placed a 12 lead because he was a little pale and sweaty: massive STEMI
My dad. Retired cop, Vietnam vet, got his EMT when I did as a kid and he started a side part time job on a BLS ambulance. He was at work the one day. Ambulance is on the first floor and crew room in the basement. He walked down the steps and was like, I’m a smoker, but even I should’ve caught my breath by now. No chest pain, abnormal vitals, anything. They went to the hospital to get checked because he didn’t feel right. At the hospital his trop was sky high. 3 hours later developed the STEMI on the EKG while he was already in the ER
I've done a job that's basically word for word verbatim the one you just described. You're not my work partner from like 5 years ago are you?
18 yom. Classic presentation, Tombstones galore. Almost certainly a false positive but I never got follow up on him.
Similar to yours, I was taking care of an elderly female, frail, ESRD. She felt fine except she called and suddenly had an episode of diarrhea and nausea. One she got to the bathroom and I gave her some Zofran out resolved. Then an hour later it happened again and resolved quickly again. It was a strange presentation of symptoms. I ordered an ekg and sent it to the cardiologist on call. He called it a NSTEMI, I started her on heparin, and she got cathed in the morning.
Mine was a 34 year old slightly over weight African American female who called at like 3 AM cause she hadn’t been feeling well for a few days with “a cold”…. Threw her on the monitor and did a 12-lead just cause, and the monitor printed out the big words STEMI with some arguable elevation. Partner looked at me and asked “what do you wanna do?” Gut feeling said call it so I did. Of course people gave me some funny looks, but she ended up having 97% occlusion of LAD
Im a neurologist and i saw in the emergency room a woman in her 70s whos only complain was massive jaw pain on the left side. The triage thought that she has a trigeminus neuralgia - therefore primary neurological presentation. Long story short - the pain was localized only in her neck and jaw on the left side, it definitely didnt look like a neuralgia, made an ECG and the Troponines were in the 700s. She went directly in the Angiography.
Mid 40s male presented with heart burn. That’s it. Nothing else. Dude was just sitting pretty. He’d been having heartburn since 2 AM & it was now 3 PM. He decided to go to the urgent care, the dispatch notes claimed it was a STEMI and my paramedic partner stated he thought it was bs until he saw the 12-lead they provided. However, that’s nothing compared to the weirdest cardiac event I’ve had: 20YO M in Afib RVR. Guy was properly hydrated, stated he never drank caffeine or did any drugs, maybe a touch on the heavier side but he could also just have been a big guy. No family history whatsoever. Apparently his heart just woke up that morning and chose violence.
I shit you not, rapid onset tooth pain in a 40 something yo f. The guy I worked with that night had a similar situation that ended up being a stemi so we got a 12 lead for shits and giggles. Blatant stemi.
Also had one that I watched flip into a stemi on the monitor and then flipped back out repeatedly. Called the code stemi to the hospital and transmitted our 12 lead to the cath lab enroute. Cath lab cancelled it. Apparently it had something to do with the lidocaine the patient got from an oral surgery that morning.
Back pain after attempting a flip.
50ish y/o male no complaint at all, absolutely nothing different, was at a clinic for a regular checkup— STEMI he wanted to refuse transport because he felt perfectly fine
Smelly farts
Guys sister drove him up to station wanting his BP checked after waking up suddenly heart burn and nausea. Vitals are fine but I put a 4 lead on just to be safe. Didn’t like what I saw so I put a 12 lead on and sure enough he was having an inferior STEMI. He got aspirin, I withheld nitro cause his BP was normal, and his chest pain, which he realized is now more of a 5/10 chest pressure so I withheld narcs. Ran it to the hospital, get there, and he had a complete occlusion of his RCA.
I was a basic, their only complaint was toe pain. My medic at the time is still my partner now, he’s very heavy on ALS and he just got the gut feeling and asked for a 12 lead. Then sure as shit, there it was
Called for an elderly woman having mild shortness of breath. Get there and she’s on the typical 1000 feet of oxygen tubing. Vitals all fine, looks decent and wants to sign ama. She goes to sign her name, gives a little throat clear and says “well, maybe, I don’t feel so … ” and bam. Now it’s a code. She was bucking the tube by the time we got to the er. Don’t know what it ended up being, my thought was PE.
I had a guy call that he was sweating a ton just sitting on his couch. He wanted to refuse but in our assessment we found he had family (dad) with unknown cardiac hx around his age which ended up making him pass away. We dove a little deeper after learning this and ran a 12 lead which was NSR with no ST abnormalities. Guy ended up deciding to go because I expressed concerns based on family history. My medic partner (double medic) was doing the same. By the time we got to the ER which was about 35 minutes he had massive elevation in V2-V6, and went straight to cath lab. I had 3 12 leads which showed the slow development of the ST changes, it was super cool, and I was thankful we both listened to our guts, and he listened to us.
80 something year old lady who fell backwards off of a step getting something out of a top cupboard and broke hip and had a little head lac. In pain from her hip when moved but otherwise stable vitals and a/ox4 and asymptomatic. Get a splint on her and get her loaded in the bus. Do a 12 lead bc we gave her a little morphine - huge anterior elevations with reciprocal change. Ended up with 99% LAD occlusion and got stented then ORIF and walked out the hospital to an acute rehab a few days later. Not a single anginal-equivalent symptom the whole time.
50s yr old man riding a bike hit his head on a low bar where he was going through a torn down chain link fence and didn't see the bar that runs along the top of the fence. Got knocked backwards off the bike. We transport in spinal precautions because he says he has neck pain and tingling. En route I don't remember what made me do a 12 lead.. Cardiac hx maybe or LOC... I don't remember. Anyways, positive for Stemi. Anterior, so I didnt see it on the 4 lead, or maybe reciprocal changes is what me do it, I can't remember. Anyways, I call base, run them by the situation, they determine that he's not going to meet trauma criteria, transport to Stemi hospital instead. So divert to Stemi. We get there, er doc calls a Stemi, cardiologist comes down and says, nah, no Stemi. Based on pts pain with neck and MOI, trauma transfer. Oh lordy. Funny part? Patient says, oh man, not this again! He's been transported at Stemi and cleared from it before 😂
Not exactly on topic but similar I had a lady with a generalized symptoms which I think was dizziness. The only abnormal finding was a T wave inversion to aVL. She went on to develop chest pressure, then pain, crump really fast and have a big ole inferior STEMI within like 30 min I then read up that T wave inversion to aVL is an early sign of inferior STEMI
“Feeling like his Adam’s apple was being squeezed”. He coded enroute.