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Challenges in Clinical Electrocardiography
February 2018

Not Your Typical ST-Elevation Myocardial Infarction

Author Affiliations
  • 1Department of Medicine, University of California, San Francisco
  • 2Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital
JAMA Intern Med. 2018;178(2):283-285. doi:10.1001/jamainternmed.2017.6318

A man in his 80s with unknown medical history was brought to the emergency department after a cardiac arrest. According to paramedics, the patient was last seen to be healthy by his family 4 hours earlier, then was found unresponsive and pulseless in the bathroom.

His initial rhythm was reported by paramedics as pulseless electrical activity. He underwent cardiopulmonary resuscitation, receiving 4 doses of epinephrine intravenously and endotracheal tube intubation with return of spontaneous circulation after approximately 10 minutes. His initial electrocardiogram (ECG) is shown in Figure 1. The patient had not been previously seen at our facility and no prior ECG was available for comparison.