Emergency Medicine News:
The Case Files
Dr. Giovannini is a senior staff physician in emergency medicine with the Henry Ford Health System in Detroit.
A nurse hands you — in the midst of a busy shift when your facility is rolling out a new EMR — an ECG that was done per protocol for nontraumatic chest pain. A 37-year-old man is complaining of four episodes of vomiting the previous night that was associated with midsternal chest burning.
Currently in the ED, the vomiting and burning have stopped, and he is complaining only of loss of appetite. His chest discomfort occurred at rest, is not pleuritic, and is not reproducible with cough, deep inspiration, and palpation. He has no associated radiation to the jaw, neck, or arm. He denies shortness of breath, dizziness, or palpitations, and his electrolytes, vital signs, and physical exam are normal.
The patient has no family medical history of coronary artery disease or early sudden death. He smokes a pack of cigarettes a day and also smokes cannabis. All STEMIs are reviewed by a committee with to-the-minute metrics of every aspect of care that you provide.
The nurse and ancillary staff are hovering over your shoulder awaiting orders for ASA, Plavix, heparin bolus, and after-hours cath lab activation. How do you interpret the ECG? Do you wake up the cath team to come in for urgent intervention?
ECGs were repeated showing similar findings. You note that no ST segment changes are noted in leads I and v1, which make a diagnosis of STEMI suspect. You re-evaluate the patient, and discover he is clutching his cell phone in his left hand. A repeat ECG is performed after the cell phone is taken out of his hand. Troponin is negative, and the patient is subsequently discharged with likely GERD.
Diagnosis: cell phone interference.