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JAMA Cardiology Clinical Challenge
January 2019

A 71-Year-Old Man With Inferior ST-Segment Elevation

Author Affiliations
  • 1Department of Cardiology, Royal Victoria Hospital, Belfast, Northern Ireland
JAMA Cardiol. 2019;4(1):81-82. doi:10.1001/jamacardio.2018.2837

A 71-year-old man presented with a 3-hour history of central chest pain associated with breathlessness. His medical history was significant for remote percutaneous coronary intervention 19 years ago, with no available details at the time of the patient’s presentation. On arrival, the patient was hemodynamically unstable, with a blood pressure of 85/55 mm Hg. He was tachycardiac, with a heart rate of 105 beats per minute, and his oxygen saturation level was 91% on room air. The patient was afebrile. Physical examination showed no jugular vein distension or peripheral edema, the presence of bibasilar rales, and no cardiac murmurs. A 12-lead electrocardiogram showed inferior ST-segment elevation in leads II, III, and aVF. The patient was transferred urgently to the cardiac catheter laboratory. Coronary angiography was undertaken via the right radial artery, and both left and right coronary arteries were selectively engaged (Figure 1 and Videos 1 and 2).