An older adult with a history of hypertension and diabetes presented to the emergency department with paroxysmal chest pain. The chest pain had occurred 6 times during the day and was relieved by sublingual nitroglycerin. On arrival, the patient’s blood pressure and pulse rate were 160/86 mmHg and 45 beats per minute (bpm), respectively. Results of a hemogram, serum electrolyte, kidney, liver, troponin I, B-type natriuretic peptide, and D-dimer tests were all within normal limits. The chest pain resolved before the initial electrocardiogram (ECG) was performed (Figure, A). The diagnosis was unstable angina, and loading doses of aspirin, ticagrelor, and atorvastatin were prescribed. On the second day of hospitalization, the chest pain recurred. A repeat ECG was performed at the onset of chest pain (Figure, B).
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Corresponding Author: Xuanxuan Li, MD, Department of Cardiology, Shijiazhuang Great Wall Hospital of Integrated Traditional Chinese and Western Medicine, Shijiazhuang, Hebei 050000, China (email@example.com).
Published Online: January 17, 2023. doi:10.1001/jamainternmed.2022.6092
Conflict of Interest Disclosures: None reported.
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:
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