A man in his 70s with a history of hyperlipidemia presented with sudden-onset chest pain that radiated to his left arm, with associated nausea and diaphoresis. Physical examination revealed a robust senior who appeared acutely ill, in obvious pain. Vital signs revealed a blood pressure of 119/62 mm Hg; pulse, 99 beats per minute and regular; and respirations, 20 breaths per minute. Oxygen saturation was 95% on ambient air. Cardiopulmonary examination disclosed a discrete 2/6 holosystolic murmur at the apex, with otherwise unremarkable findings. Chest x-ray was clear. His electrocardiogram (ECG) on presentation is shown in the Figure.
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Brenes-Salazar JA. ST-Segment Elevation in Lead aVRA Visual Reminder of Potential Catastrophe. JAMA Intern Med. 2018;178(6):847–848. doi:10.1001/jamainternmed.2018.0928
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