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The Symptoms: Dyspnea and Chest Pain

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

Cases in Electrocardigraphy

Dr. Harrigan is an associate professor of emergency medicine and the associate research director in the department of emergency medicine at Temple University Hospital and School of Medicine in Philadelphia

Dr. Chan is an associate professor of clinical medicine, emergency medicine, the director of CQI, and the associate medical director of the department of emergency medicine at the University of California, San Diego

Dr. Brady is an associate professor and the program director in the department of emergency medicine at the University of Virginia School of Medicine in Charlottesville.

A 30-year-old man presented to the ED with dyspnea, beginning somewhat suddenly, accompanied by subjective fevers, nonproductive cough, and pleuritic chest pain. Past medical history was significant for spina bifida, which left him bedridden.

He denied a history of cardiac disease, pneumonia, pulmonary embolism, or pneumothorax. Physical examination revealed an obese male, with mild diaphoresis and increased work of breathing. Vital signs were temperature, 99.8°F; heart rate, 115 beats per minute; respiratory rate, 26 breaths per minute, and blood pressure, 142/92 mmHg.

Lungs were clear bilaterally. The remainder of the examination was unremarkable. Below is the initial 12-lead ECG. What diagnosis do you suspect? See p. 12.

Figure. EC

Figure. EC

© 2002 Lippincott Williams & Wilkins, Inc.