A patient in their 60s presented to the emergency department with approximately 20 minutes of acute, severe precordial chest pain radiating to their left arm at night, accompanied by dyspnea, dizziness, and sweating. The patient’s medical history was notable for hypertension, cerebral infarction, diabetes, and nicotine addiction. On the patient’s arrival, the vital signs showed blood pressure of 188/101 mm Hg, heart rate at 84 beats/min, and respiratory rate at 20 breaths/min. The initial serum cardiac troponin I level of the patient was lower than 0.05 ng/mL (normal range, <0.16 ng/mL; to convert to μg/L, multiply by 1) and the potassium level was 4.1 mEq/L (normal range, 3.5-5.3 mEq/L; to convert to mmol/L, multiply by 1). The patient’s 12-lead electrocardiogram (ECG) obtained on admission is shown in the Figure, A.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Tong Liu, MD, PhD, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23, Pingjiang Road, Hexi District, Tianjin 300211, People’s Republic of China (email@example.com).
Published Online: November 28, 2022. doi:10.1001/jamainternmed.2022.5057
Conflict of Interest Disclosures: None reported.
Funding/Support: The work was funded by Tianjin Key Medical Discipline (Specialty) Construction Project.
Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: The authors thank Nan Zhang, MD, Second Hospital of Tianjin Medical University, and Chuan-Hai Zhang, MD, The First Affiliated Hospital of Jinzhou Medical University, who were not compensated, for their helpful comments.
Additional Information: Drs Zhao and Jia are co–first authors. They contributed equally to this work.
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:
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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