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Challenges in Clinical Electrocardiography
April 11, 2011

The Serial Electrocardiogram: An Important Tool in the Assessment of Chest Pain

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Arch Intern Med. 2011;171(7):616-618. doi:10.1001/archinternmed.2011.99

A 59-year-old man with hypertension and diabetes was brought to the hospital by ambulance after calling emergency medical services for severe substernal chest pain that began while playing volleyball. The chest pain radiated to the back and was accompanied by shortness of breath. The patient had never had pain of this type before and he reported good overall exercise tolerance. His medication regimen consisted of lisinopril, metformin, and glyburide. The patient was a nonsmoker with no notable family history of coronary artery disease. Aspirin and nitroglycerin were administered in the ambulance. On arrival to the emergency department, the patient's chest pain had resolved. His blood pressure was 97/68 mm Hg and heart rate, 75 beats/min (regular). An electrocardiogram (ECG) was obtained (Figure 1). The computer interpretation of the ECG was “anteroseptal infarct, age undetermined.” No prior ECGs were available.

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