An electrocardiogram opinion from an National Health Service walk-in centre

Clinical introduction

A previously fit and well 28-year-old man was referred by his general practitioner to a nearby NHS walk-in centre for an ECG. He presented with a 1-day history of mild pleuritic chest discomfort and dyspnoea while at work. Simple analgesics alleviated the discomfort and improved the dyspnoea slightly. He had a BP of 121/78, a HR of 66 bpm and had an oxygen saturation of 98%. The ECG was electronically sent to a cardiologist based at the local tertiary centre because of its appearance (figure 1).

Question

What are the changes on the ECG most likely to represent?

Dextrocardia

Pericarditis with global pericardial effusion

Pneumothorax

Inferior ST elevation myocardial infarction (STEMI)

Answer: C

The patient was promptly sent to the local ED, where a large left-sided pneumothorax was confirmed (figure 2). The patient made a full...

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