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Cardiology

An Unusual Cause of ST-Segment Elevation in the Right Precordial Leads—A Clue From the Humble Waves

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JAMA Internal Medicine

Published Online: April 17, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Yan Chen, MD¹;

Gujiang Chen, MD¹;

Yuan Zhang, MD²

Author Affiliations

¹Department of Electrocardiology, Haining People’s Hospital, Zhejiang Province, China
²Department of Cardiology, Haining People’s Hospital, Zhejiang Province, China

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A patient in their late teens presented to the outpatient department stating that they had felt the implanted cardioverter defibrillator (ICD) deliver a shock 3 times within the past 6 months. The patient had a history of cardiac arrest due to ventricular fibrillation and had received an ICD 20 months ago. On admission, the patient’s vital signs were as follows: temperature, 36.4 °C; blood pressure, 114/69 mm Hg; pulse rate, 70 beats/min; and respiratory rate, 18 breaths/min. Cardiopulmonary examination was unremarkable. Troponin I, N-terminal probrain natriuretic peptide (NT-pro BNP), and D-dimer levels were normal. The 12-lead electrocardiogram (ECG) obtained at admission is shown in the Figure.

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A patient in their late teens presented to the outpatient department stating that they had felt the implanted cardioverter defibrillator (ICD) deliver a shock 3 times within the past 6 months. The patient had a history of cardiac arrest due to ventricular fibrillation and had received an ICD 20 months ago. On admission, the patient’s vital signs were as follows: temperature, 36.4 °C; blood pressure, 114/69 mm Hg; pulse rate, 70 beats/min; and respiratory rate, 18 breaths/min. Cardiopulmonary examination was unremarkable. Troponin I, N-terminal probrain natriuretic peptide (NT-pro BNP), and D-dimer levels were normal. The 12-lead electrocardiogram (ECG) obtained at admission is shown in the Figure.

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Article Information

Corresponding Author: Yuan Zhang, MD, Department of Cardiology, Haining People’s Hospital, No. 2 West Qianjiang Rd, Haining 314400, Zhejiang Province, China (zhangyuan6162022@163.com).

Published Online: April 17, 2023. doi:10.1001/jamainternmed.2023.0294

Conflict of Interest Disclosures: None reported.

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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.