It’s Sunday morning 10 am and a patient finally pops up on the whiteboard: “19 Y M, CHEST PAIN.” Your favorite.
The patient is a 19 year-old man with no PMH BIBEMS with chest pain. He lifted weights yesterday, and this morning woke up with soreness in his mid chest area that resolved on its own. There was no associated dyspnea, hemoptysis, pleuritic chest pain, or diaphoresis. On further questioning, he denied any recent travel, leg swelling, history of cancer or cardiac risk factors or any family history of early death or MI. This was his first time ever experiencing such pain, which scared him and promoted him to come to your ED. Currently, he is asymptomatic and a little embarrassed.
ROS: As stated above
SHx: Only drinks alcohol occasionally
Triage VS: T 982.F, HR 56, RR 18, BP 140/79, O2 100%
General: Well-appearing young man, NAD, lying comfortably in bed
HEENT: NCAT, PERRLA, pupils 3mm bilaterally, EOMI, MMM, neck supple
CVS: RRR, S1/S2, no murmurs/rubs/gallops, no chest wall tenderness
Chest: CTAB, breathing comfortably
Abd: Soft, NTND, normoactive bowel sounds
Msk: No edema, pulses 2+ in all four extremities
Ready to send this young man home, you quickly glance at his triage ECG and see this:
Discuss the ECG findings.
- What is the abnormal finding?
- With what condition is this finding associated? How sensitive and specific is this finding?
- What would be your next step in management of this patient?