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Challenges in Clinical Electrocardiography
January 10, 2011

ST-Segment Elevation in a Patient Receiving Flecainide—Discussion

Author Affiliations


Arch Intern Med. 2011;171(1):12-13. doi:10.1001/archinte.171.1.11a

After the initial ECG was obtained, the patient was transferred by ambulance to the emergency department, where the cardiac catheterization team was activated for possible ST-segment elevation MI (STEMI) based on the ECG findings and the clinical presentation of chest pressure and hypotension. On evaluation, the cardiology team was suspicious that the apparent ST-segment elevation was owing to unrecognized atrial flutter (Figure 2and Figure 3). The patient was treated with intravenous adenosine, which revealed underlying flutter waves (Figure 4). While the patient was being informed of the options for termination of the arrhythmia, he spontaneously converted to sinus rhythm. A second ECG demonstrates normal ST segments (Figure 5). He was admitted for overnight observation and was discharged home the next day after a negative result for serial troponins and a normal stress sestamibi test result.

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