An 87-year-old male with past medical history of valvular atrial fibrillation, prior stroke, and heart failure presents to urgent care with chest pain and shortness of breath for 3 days. The pain and difficulty breathing are associated with bilateral lower extremity swelling for 1 week.              

View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Ashman phenomenon
Figure 1. (Case presented by Whitney Skidmore, MD, PGY2 McGovern Medical School, Department of Emergency Medicine, UTHealth Houston with assistance from Catie Reynolds, MD, McGovern Medical School, Department of Emergency Medicine, UTHealth Houston.)
An 87-Year-Old Male with Chest Pain, SOB, and a History of Valvular AFib, Stroke, and Heart Failure
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