Author: Alec Feuerbach MD
Edited by Robby Allen MD
(Thanks to Dr. Robby Allen for contributing this ECG)
The Case:
A 50-year-old woman with no history of cardiac disease presents with severe, intermittent chest pain radiating to the back and left arm with associated left arm numbness. She has been feeling this pain off and on for a week or two now and cannot recall what makes it better or worse, but because her pain acutely worsened she decided to come to the ED today. She denies shortness of breath, fever, chills, and cough and has not had abdominal pain, nausea, or vomiting. On exam, she is clearly in pain and distress. Her heart rate is 87, blood pressure is 188/115, POx is 100% on room air, and she is afebrile. Her mental status is normal, lungs are clear, heart sounds are normal, and she has good, strong, and equal pulses bilaterally. She has no chest or abdominal tenderness. Her clinical status is okay for the moment, but you are worried about her ongoing pain. You are handed the following ECG.
What are your next steps in managment?
feuerbacham
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2 Comments
Julian · December 17, 2020 at 9:41 am
suggestive of R sided ischemia, elevations V1>V2, III>II
MJ Murphy · December 20, 2020 at 6:57 am
Also TWI in inferior leads, no q waves, possible acute ischemia