The patient is a 72-year-old woman who presents with 2 hours of chest pain with associated diaphoresis. She has a remote history of breast cancer. No leg pain or swelling or history of pulmonary embolism.
On exam, you find her stated weight of 313 pounds is correct. In addition:
- General: Alert and oriented X 3, ambulatory
- Lungs: Clear to auscultation
- Cardiovascular: RRR without m/r/g, distant heart sounds
- Abdomen: Soft and NT without r/r/g
- Ext: Normal without swelling, pulses 2+ and equal X 4 extremities
An ECG is ordered, as seen above. Review the image and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.