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Point-of-Care Ultrasonography in Suspected Acute Coronary Syndrome

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JAMA Internal Medicine

Published Online: October 2, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Karan Kalani, MD¹;

A. Shaheer Ahmed, MD, DM¹;

Enosh Katta, MD¹

Author Affiliations

¹Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India

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A patient in their 40s, with a known case of post-tubercular bronchiectasis and receiving long-term domiciliary oxygen therapy, presented with acute exacerbation of dyspnea for the past 2 days. There was no associated history of chest pain. On presentation to the hospital, the patient was in a gasping state. Carotid pulse and blood pressure were nonrecordable. Initial rhythm was suggestive of pulseless electrical activity, and cardiopulmonary resuscitation was initiated per advanced cardiac life support guidelines. The rhythm after return of spontaneous circulation is depicted in the Figure, A.

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A patient in their 40s, with a known case of post-tubercular bronchiectasis and receiving long-term domiciliary oxygen therapy, presented with acute exacerbation of dyspnea for the past 2 days. There was no associated history of chest pain. On presentation to the hospital, the patient was in a gasping state. Carotid pulse and blood pressure were nonrecordable. Initial rhythm was suggestive of pulseless electrical activity, and cardiopulmonary resuscitation was initiated per advanced cardiac life support guidelines. The rhythm after return of spontaneous circulation is depicted in the Figure, A.

Questions: What are the electrocardiogram (ECG) findings? How can these findings be interpreted in the given clinical context?

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Article Information

Corresponding Author: Karan Kalani, MD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India 605006 (kalani.karan1993@gmail.com).

Published Online: October 2, 2023. doi:10.1001/jamainternmed.2023.2855

Conflict of Interest Disclosures: None reported.

References

Krenke R , Nasilowski J , Przybylowski T , Chazan R . Electrocardiographic changes in patients with spontaneous pneumothorax. J Physiol Pharmacol. 2008;59(suppl 6):361-373.PubMed Google Scholar

Abdelghany M , Chaudhary A , Liu K . Chest pain in an 18-year-old man. Circulation. 2017;136(5):502-504. doi:10.1161/CIRCULATIONAHA.117.029897 PubMed Google Scholar Crossref

Alzghoul B , Innabi A , Shanbhag A , Chatterjee K , Am F , Meena N . Iatrogenic right-sided pneumothorax presenting as ST-segment elevation: a rare case report and review of literature. Case Rep Crit Care. 2017;2017:3291751. doi:10.1155/2017/3291751 PubMed Google Scholar Crossref

Velayutham R , Parale C , Kumar R , Anantharaj A . Coronary cusp thrombosis: a rare cause of myocardial infarction. J Echocardiogr. 2023;21(3):131-133. doi:10.1007/s12574-022-00573-w 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 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.