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Challenges in Clinical Electrocardiography
September 26, 2022

The Imposter Dance of Alternating QRS Complexes

Author Affiliations
  • 1Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
JAMA Intern Med. 2022;182(11):1212-1213. doi:10.1001/jamainternmed.2022.3965

A patient in their late 50s presented to the emergency department for acute onset chest pain with diaphoresis. The patient reported having had chest tightness followed by mild dyspnea after rushing down a set of stairs 2 days prior. The pain had gradually subsided after resting. In addition, on the evening of admission, just after finishing a meal, the patient experienced a fairly sudden onset of severe nonradiating pressure-like pain in the central portion of the chest accompanied by cold sweating; the pain persisted and progressed. Self-reported medical history included smoking 1 pack of cigarettes daily for more than 3 decades and taking medications for type 2 diabetes and hypertension.

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