81 yo with Chest Pain and radiation into the jaw
Oct 21, 2026An 81 yo male presents to triage with chest pain. The pain started last evening ie., 14 hours previously and is still present.
The pain is described as a pressure pain with some radiation into the jaw area. There is no diaphoresis, no dyspnoea and no distress.
There is minimal past medical history.
An ECG is done. Take a moment to look at it.
QUESTION: What does it show?
ANSWER
.
.
There is an INFERIOR infarct. In most cases this is due to a RIGHT CORONARY ARTERY occlusion but in a small number of cases a left circumflex artery occlusion can also cause this.
A right coronary occlusion is most likely as when the following are present:
- STE in III > STE in II and
- there is some ST depression in I (see below).
If this were a circumflex lesion, these changes would not have occurred.
The patient gets ASPIRIN and you prepare to give GTN.
QUESTION: Should you give GTN? What ECG should you perform before this?
We know that up to half of all patients with an inferior infar...
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