A current smoker in their 50s with uncontrolled hypertension presented with acute substernal chest pain and shortness of breath. On presentation, their blood pressure was 206/97 mm Hg, heart rate was 106 beats per minute, and they had an elevated high-sensitivity troponin level of 125 ng/L (upper level of normal, 15 ng/L). The presenting electrocardiogram (ECG) is shown (Figure). The chest pain continued despite treatment with intravenous nitroglycerine. Results of an echocardiogram revealed hypokinesis of the distal septum with a mildly reduced left ventricular ejection fraction of 40% to 50%.
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Hasnie UA, Patel H, Doppalapudi H. An Unusual Case of Chest Pain With Wide Complex Arrhythmia—No Stents Needed. JAMA Intern Med. Published online February 22, 2021. doi:10.1001/jamainternmed.2020.8999
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