The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports).

The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find:

  • BP: 154/102
  • Pulse: 68
  • Sat: 99%
  • Temperature: 97.3°F

View the electrocardiogram taken (Figure 1) and consider what your next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: June, 2009

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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