DR THOMAS BROUGH
50yoM P/W exertion chest pain and diaphoresis.
Remote history of whitecoat, no medications; completely healthy until today; worked in business.
Inferior STEMI on ECG with some bradycardia.
450km from cath lab, in an ED where we thrombolyse STEMIs.
Aspirin downrange, about to give ticagrelor, heparin bolus, and 40mg tenecteplase.
Had a look for no reason in particular other than it was my want.
And indeed it was worth a look... (PLAX followed by suprasternal views)
Type A dissection, tPA and heparin withheld, flown to tertiary hospital, arrested a few times, survived neurologically intact.
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