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Challenges in Clinical Electrocardiography
July 12, 2021

A Mimic of Myocardial Ischemia in a Woman With Hyperemesis Gravidarum

Author Affiliations
  • 1Department of Cardiology, Gold Coast University Hospital, Southport, Queensland, Australia
  • 2The University of Queensland, Brisbane, Queensland, Australia
JAMA Intern Med. Published online July 12, 2021. doi:10.1001/jamainternmed.2021.3053

A woman in her 20s who was 12 weeks pregnant presented to the emergency department with a 2-day history of severe chest pain and palpitations. She had been experiencing nausea and vomiting during the past 5 weeks, which had worsened in the preceding 4 days. On examination, the patient’s blood pressure was 111/83 mm Hg, oxygen saturation was 96% on room air, and heart rate was 140 beats per minute, which settled to 90 beats per minute with intravenous fluids. She had dry mucous membranes, but the results of a cardiopulmonary examination were otherwise normal. Results of the electrocardiogram (ECG) at admission showed widespread ST segment depression with ST elevation in lead aVR (Figure, A).

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