It was a topsy-turvy hour and 45 minutes of tennis in the shade of the London sunshine and Dimitrov was forced to rally from a set down in the deciding set.
The duo traded seven breaks of serve with the Russian responding to a dismal opening set by finding his feet in the second frame.
The match was yet to get underway before Medvedev required a medical time out on his right shoulder.
The Russian appeared to strain the muscle during the warm-up and the pattern of the opening set suggested that the Russian’s afternoon would be over before too long.
Dimitrov stretched his opponent from pillar to post in the second service game and broke after a lengthy baseline exchange.
He consolidated for 3-0 and the pressure being exerted by the Bulgarian was telling when he fashioned five break points in the fourth game.
Medvedev eventually wilted when he sent a backhand long and when he finally held serve for 5-1 it was little more than a consolation.
Dimitrov tied up the opening set in just over half an hour of action but the procession that many believed set two would be, didn’t materialize.
The Russian was striking the ball freely, constructing his first break point in the second game of set two.
He failed to convert but he wouldn’t have to wait too long to edge ahead in the set.
Dimitrov’s level dipped, coughing up three separate break points and, although two were salvaged, he came out second best during a rally in which Medvedev confirmed the break.
The Russian’s ace count began to rack up and he leveled the match after an hour and ten minutes.
And when he broke to love in the third game of the deciding set Dimitrov would have been forgiven for thinking the worst.
His first serve % had plummeted rapidly and his nominally wicked slice was playing straight into the hands of the 21-year-old.
But he broke straight back with a sublime backhand flick that caught the towering Medvedev off-guard and confidence was restored.
He consolidated the break with a love hold and brought up the decisive break point a game later.
The Russian, stooping low to return a slice, netted a backhand that he would be left to rue and Dimitrov pumped his fist.
A second Queen’s title remains within grasp.