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Challenges in Clinical Electrocardiography
December 2017

A Case of Chest Pain and Transient Cardiac Arrest

Author Affiliations
  • 1Libin Cardiovascular Institute of Alberta, University of Calgary Cummings School of Medicine, Calgary, Alberta, Canada
JAMA Intern Med. 2017;177(12):1845-1846. doi:10.1001/jamainternmed.2017.5853

A woman in her 50s with a medical history of hypertension, hypothyroidism, and dyslipidemia presented to the emergency department with 15-minute episode of severe rest angina on a background of a 3-month history of self-limited exertional dyspnea and typical chest discomfort associated with diaphoresis and nausea. She had no chest pain on assessment, and her initial vital signs revealed a heart rate of 56 bpm, blood pressure of 145/96 mm Hg (similar in both arms), and normal respiratory rate. Her precordial examination findings were noncontributory, with no extra heart sounds or murmurs. Complete blood cell count, serum chemical analysis, and serial troponin levels were normal, and her initial electrocardiogram (ECG) in the emergency department was unremarkable. She was admitted to the cardiology service and treated for unstable angina. Twenty-four hours into her admission, she had a recurrence of her chest discomfort with acute loss of consciousness and no palpable pulse. Her ECG on the telemetry is shown in the Figure.

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