This is not ‘NSR’!

Authors: Stephen Ojo / Editor: Steve Corry-Bass / Reviewer: Erden Erol Unluer / Codes: / Published: 30/12/2022

A 69-year-old male lifelong smoker presents to the Emergency Department (ED) with the history of chest pain 4 hours prior to presentation. He describes it as a band-like pain around his chest and he was sweaty, clammy, and nauseous. The symptoms have persisted all evening. One week earlier and also 3 days prior, he had a similar pain on exertion- intermittent in nature which both resolved spontaneously within 2 -3 hours. He has no medical problems.

General and Systemic Examination are unremarkable.

An ECG done at triage has been interpreted as Normal Sinus rhythm (NSR) but on review, showed a deep T wave inversion in V2 V4 with 1.5mm (subtle) ST elevation in V2 V3.

His Blood Tests showed normal Full blood count, Urea and electrolytes and a high troponin.

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