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Acute Coronary Syndromes

Chest Pain and Wide QRS Tachycardia

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JAMA Internal Medicine

Published Online: April 10, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

János Tomcsányi, MD, PhD¹;

Péter Arányi, MD, PhD¹

Author Affiliations

¹Department of Cardiology, Buda Hospital of the Hospitaller Order of St John of God, Budapest, Hungary

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A patient in their 70s with diabetes presented with 3 hours of chest pain. The patient had a history of acute myocardial infarction 5 years before, with stenting of the right coronary artery and left anterior descending coronary artery. At the current hospital admission, the patient denied any dyspnea but felt dizzy while in the sitting position. The patient’s supine blood pressure measured 100/55 mm Hg. Laboratory test results revealed a 83 ng/L serum troponin T level (upper limit of normal [ULN], 14 ng/L; to convert to μg/L, multiply by 1) and 76 U/L serum creatine kinase level (ULN, 170 U/L; to convert to μkat/L, multiply by 0.0167).

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A patient in their 70s with diabetes presented with 3 hours of chest pain. The patient had a history of acute myocardial infarction 5 years before, with stenting of the right coronary artery and left anterior descending coronary artery. At the current hospital admission, the patient denied any dyspnea but felt dizzy while in the sitting position. The patient’s supine blood pressure measured 100/55 mm Hg. Laboratory test results revealed a 83 ng/L serum troponin T level (upper limit of normal [ULN], 14 ng/L; to convert to μg/L, multiply by 1) and 76 U/L serum creatine kinase level (ULN, 170 U/L; to convert to μkat/L, multiply by 0.0167).

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Article Information

Corresponding Author: Péter Arányi, MD, PhD, Department of Cardiology, Buda Hospital of the Hospitaller Order of St John of God, Árpád fejedelem útja 7, POB 98, Budapest 1023, Hungary (aranyi.p@gmail.com).

Published Online: April 10, 2023. doi:10.1001/jamainternmed.2023.0287

Conflict of Interest Disclosures: None reported.

References

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Littmann L , Olson EG , Gibbs MA . Initial evaluation and management of wide-complex tachycardia: A simplified and practical approach. Am J Emerg Med. 2019;37(7):1340-1345. doi:10.1016/j.ajem.2019.04.027 PubMed Google Scholar Crossref

Gorenek B , Blomström Lundqvist C , Brugada Terradellas J , et al. Cardiac arrhythmias in acute coronary syndromes: position paper from the joint EHRA, ACCA, and EAPCI task force. Europace. 2014;16(11):1655-1673. doi:10.1093/europace/euu208 PubMed Google Scholar Crossref

Demidova M , Ulfarsson AQ , Carlson J , et al. Early monomorphic ventricular tachycardia is associated with increased long-term mortality in STEMI. Eur Heart J. 2020;41:S2. doi:10.1093/ehjci/ehaa946.1783 Google Scholar Crossref

Dorian P , Cass D , Schwartz B , Cooper R , Gelaznikas R , Barr A . Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med. 2002;346(12):884-890. doi:10.1056/NEJMoa013029 PubMed Google Scholar Crossref

Somberg JC , Bailin SJ , Haffajee CI , et al. Intravenous Lidocaine versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia. Am J Cardiol. 2002;90:853-859. doi:10.1016/S0002-9149(02)02707-8 PubMed Google Scholar Crossref

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.