A patient in their 60s with a history of long-term uncontrolled hypertension presented to the emergency department reporting left hip pain and reduced mobility owing to a fall 2 days prior. A hip fracture was suspected, and external fixation and skin traction were performed after admission to the orthopedics department. In the early morning of day 2 after admission, the patient suddenly lost consciousness. A 12-lead electrocardiogram (ECG) was immediately performed; its findings are shown in Figure, A. For comparison, the findings of an ECG performed before admission are shown in Figure, B. The patient’s high-sensitivity cardiac troponin-I serum level was 0.21 µg/L (reference, <0.023 µg/L). Findings of a neurologic examination showed bilateral pupil size, 2.5 mm; right limbs, unresponsive to pain stimuli and with hypotonia; all limbs, reduced tendon reflex; and bilateral Babinski reflex, negative. Acute myocardial infarction was suspected, and a cardiologist was consulted.
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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: Fengguang Kang, MD, Guangzhou University of Chinese Medicine, No. 12 Jinsha Rd, Daliang Town, Shunde District, Foshan, Guangdong 528000, China (firstname.lastname@example.org).
Published Online: March 20, 2023. doi:10.1001/jamainternmed.2022.6618
Conflict of Interest Disclosures: Dr Kang reported support from the Key Medical Talents Training Project of Shunde District, Foshan, China (No. 202211001). No other disclosures were 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:
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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