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Cases in Electrocardigraphy

The Symptoms: Chest Pain with ST Segment Elevation in a Cocaine User

Brady, William J. MD; Harrigan, Richard MD; Chan, Theodore MD

doi: 10.1097/01.EEM.0000292628.13806.9e

    On initial presentation, a 40-year-old man presented to the ED with substernal chest pain. He had recently smoked a “large amount” of cocaine.

    The examination revealed a patient in considerable distress with diaphoresis, clutching his chest. The remainder of the examination was unremarkable. A 12-lead ECG shown here demonstrated sinus rhythm with ST segment elevation.

    What therapy should be initiated? See p. 30.

    Figure 1
    Figure 1:
    Normal sinus rhythm with ST segment elevation in leads II, III, aVf, and V2 to V6. Also, the T waves are very prominent in leads V2 to V4. The initial, upsloping portion of the ST segment is concave, suggestive of a non-AMI etiology of the elevation.
    © 2001 Lippincott Williams & Wilkins, Inc.