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PR Segment—A Neglected Electrocardiogram Profile in Acute Chest Pain

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1 Credit CME

A patient in their 40s with no medical history presented to the emergency department with chest pain of a 4-hour duration. The pain was substernal, intensified by lying supine, and relieved by leaning forward. On admission, the patient’s vital signs included a temperature of 37.3 °C, blood pressure of 147/93 mm Hg, pulse rate of 103 beats/min, and respiratory rate of 20 breaths/min. The results of the rest of the physical examination were normal. The troponin I and N-terminal pro–brain natriuretic peptide levels were normal. A transthoracic echocardiogram demonstrated normal ventricular ejection fraction, chamber size, and motion and the absence of pericardial effusion. The 12-lead electrocardiogram (ECG) at admission is shown in the Figure, A.

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A patient in their 40s with no medical history presented to the emergency department with chest pain of a 4-hour duration. The pain was substernal, intensified by lying supine, and relieved by leaning forward. On admission, the patient’s vital signs included a temperature of 37.3 °C, blood pressure of 147/93 mm Hg, pulse rate of 103 beats/min, and respiratory rate of 20 breaths/min. The results of the rest of the physical examination were normal. The troponin I and N-terminal pro–brain natriuretic peptide levels were normal. A transthoracic echocardiogram demonstrated normal ventricular ejection fraction, chamber size, and motion and the absence of pericardial effusion. The 12-lead electrocardiogram (ECG) at admission is shown in the Figure, A.

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Article Information

Corresponding Author: Yangyi Lin, MD, Department of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, China (dr.linyangyi@outlook.com).

Published Online: October 3, 2022. doi:10.1001/jamainternmed.2022.4037

Conflict of Interest Disclosures: None reported.

References
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Alzand  BS , Gorgels  AP .  Combined anterior and inferior ST-segment elevation: electrocardiographic differentiation between right coronary artery occlusion with predominant right ventricular infarction and distal left anterior descending branch occlusion.   J Electrocardiol. 2011;44(3):383-388. doi:10.1016/j.jelectrocard.2011.02.002PubMedGoogle ScholarCrossref
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Adler  Y , Charron  P , Imazio  M ,  et al; ESC Scientific Document Group.  2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC).   Eur Heart J. 2015;36(42):2921-2964. doi:10.1093/eurheartj/ehv318PubMedGoogle ScholarCrossref
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Dudzinski  DM , Mak  GS , Hung  JW .  Pericardial diseases.   Curr Probl Cardiol. 2012;37(3):75-118. doi:10.1016/j.cpcardiol.2011.10.002PubMedGoogle ScholarCrossref
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Ariyarajah  V , Spodick  DH .  Acute pericarditis: diagnostic cues and common electrocardiographic manifestations.   Cardiol Rev. 2007;15(1):24-30. doi:10.1097/01.crd.0000210645.89717.34PubMedGoogle ScholarCrossref
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Tingle  LE , Molina  D , Calvert  CW .  Acute pericarditis.   Am Fam Physician. 2007;76(10):1509-1514.PubMedGoogle Scholar
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Patton  KK , Ellinor  PT , Ezekowitz  M ,  et al; American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology and Council on Functional Genomics and Translational Biology.  Electrocardiographic early repolarization: a scientific statement from the American Heart Association.   Circulation. 2016;133(15):1520-1529. doi:10.1161/CIR.0000000000000388PubMedGoogle ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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