A patient in their 60s with no previously known cardiac disease presented with a 6-hour history of sudden-onset worsening chest pain associated with shortness of breath and diaphoresis via emergency medical services (EMS). On arrival at the emergency department (ED) the patient had ongoing chest pain, rated at 8 out of 10 in intensity. The patient was afebrile. The patient’s blood pressure was 127/79 mm Hg, heart rate was 106 beats per minute, and respiration rate was 22 breaths per minute. The cardiopulmonary examination was overall unremarkable. The electrocardiograms (ECGs) obtained by EMS showed ST-segment elevation (STE), up to 2 to 3 mm in amplitude, in leads II, III, and aVF, and less in amplitude in precordial leads (Figure, A). However, the repeated ECG on arrival at the ED showed that the inferior STE resolved with development of T-wave inversion (TWI) in leads III and aVF, the STE became more prominent in leads V2 and V3, and new STE occurred in leads I and aVL (Figure, B). Due to ongoing chest pain and abnormal ECGs, ST-segment elevation myocardial infarction (STEMI) code was activated. The patient underwent emergency cardiac catheterization and coronary angiography.
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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: Ruihai Zhou, MSc, MD, RPVI, Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, 160 Dental Circle, Campus Box 7075, Chapel Hill, NC 27599-7075 (firstname.lastname@example.org).
Published Online: July 3, 2023. doi:10.1001/jamainternmed.2023.1723
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.
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