Chest Pain with an Unusual ECG

Author: Ali Alharazi, Abdullah Lashrf / Editor: Nick Tilbury / Codes: / Published: 21/09/2023

You have just had your coffee break at 2am when the ambulance brings in a 40-year-old patient who is clutching his chest and is visibly anxious. The paramedics think he is having a heart attack.

The patient tells you he woke up with crushing chest pain, nausea and sweating 30 minutes earlier. He is given aspirin 300 mg orally and morphine 5mg and metoclopramide 10 mg intravenously.

The patient has a 20 pack-year smoking history but no other cardiovascular risk factors.

On assessment his heart rate is 74 BPM, BP 145/87 with normal temperature, and oxygen saturation.

Clinical examination is unremarkable

His ECG is shown below:

Fig. 1 via Life in the Fast Lane

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