Course: Serial Electrocardiograms—An Unsung Hero
CME Credits: 1.00
Released: 2023-05-01
A patient in their 60s presented to the emergency department because of retrosternal chest pain for the past 5 hours. The patient was known to have diabetes and hypertension and a 40-pack-year smoking history. The patient had similar episodes of chest pain in the past, which were aggravated with exertion and relieved with resting. At presentation, blood pressure was 141/90 mm Hg; pulse, 89 beats/min; respiratory rate, 22 breaths/min; and oxygen saturation, 99% on room air. The electrocardiogram (ECG) obtained at presentation is shown in the , A. Loading doses of aspirin and clopidogrel were administered along with sublingual nitroglycerin, after which the patient reported partial relief of chest pain, and a second ECG was obtained. High-sensitivity cardiac troponin assay was performed and returned negative (<0.05 ng/mL; to convert to ?g/L, multiply by 1.0). However, the patient’s chest pain recurred after a half hour, during which another ECG was obtained, which is shown in the , B.
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