A man in his 30s with a medical history of remote pulmonary embolus (PE) and antiphosholipid antibody (APLA) syndrome presented to the emergency department with progressive dyspnea on exertion of 3 months’ duration. He also reported subacute, occasional, dull, substernal and right-sided exertional chest pain and a 10-pound unintentional weight loss. His temperature was 36.4°C; heart rate, 60 bpm; blood pressure, 117/82 mm Hg; respirations, 18/min; and resting oxygen saturation, 98% on ambient air. However, his oxygen saturation decreased to 82% with ambulation. The other findings of his physical examination were largely unremarkable, other than widened splitting of S2. The laboratory evaluations, including cardiac troponin levels, were unremarkable. The initial electrocardiogram (ECG) is shown in the Figure.
Strizich Tull L, Goldberger ZD. A Case of Nonischemic T-Wave InversionsOff the Deep End. JAMA Intern Med. 2014;174(11):1834-1836. doi:10.1001/jamainternmed.2014.4754