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Teachable Moment
Less Is More
February 2017

Chest Pain and Supplemental Oxygen: Too Much of a Good Thing?

Author Affiliations
  • 1Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
JAMA Intern Med. 2017;177(2):266-267. doi:10.1001/jamainternmed.2016.7612

A man in his 60s with hypertension, dyslipidemia, and coronary artery disease presented with intractable retrosternal chest pain. The patient’s vital signs were normal and his oxygen saturation on room air was above 95%. The paramedics started him on oxygen by nonrebreathing face mask and he was transferred to our emergency department where oxygenation was continued. A 12-lead electrocardiogram revealed anterior ST-elevations and a chest radiograph showed no intrathoracic pathology. The patient underwent urgent cardiac catheterization with 2 drug-eluting stents placed in the left anterior descending artery achieving good postprocedure flow. Oxygen was stopped 2 days later. His postprocedure course was complicated by recurrent episodes of nonsustained ventricular tachycardia and atrial fibrillation requiring an amiodarone infusion. A transthoracic echocardiogram performed 24 hours after presentation revealed a left ventricular ejection fraction of 30% to 35%. The ventricular function remained decreased 6 weeks later.