A patient in their 70s presented to the emergency department with chest tightness and shortness of breath for 5 hours and loss of consciousness for 10 minutes. The patient’s medical history included metastatic rectal cancer and hypertension. On admission, the patient had a temperature of 36.0 °C, blood pressure of 52/26 mm Hg, pulse rate of 45 beats per minute, and respiratory rate of 6 breaths per minute. Examination revealed ecchymosis on the lower limbs, whereas cardiopulmonary examination was unremarkable. The N-terminal pro-brain natriuretic peptide level was 6770 ng/L (reference, 300-900 ng/L); however, the troponin I level was normal. A 12-lead electrocardiogram (ECG) obtained at admission is shown in Figure, A.
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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, No. 167, Beilishi Road, Beijing 100037, China (email@example.com).
Published Online: March 27, 2023. doi:10.1001/jamainternmed.2022.7027
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:
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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