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Symptoms: Elderly Woman with Chest ‘Muscle Tightness’

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

Cases in Electrocardiography

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; and 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.

A 76-year-old woman with a history of hypertension presented to the emergency department with one day of chest pain. The pain started when she woke that morning, and was not related to exertion. She described the pain as a “muscle tightness,” 3/10 in severity, constant in nature, and exacerbated by deep inspiration with some subjective shortness of breath.

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She denied pain radiation, nausea, diaphoresis, palpitations, or lightheadedness. Her only cardiac risk factors were hypertension and a distant history of smoking. On exam, her pulse rate was 86 beats per minute, blood pressure 133/54 mm Hg, respiratory rate of 18 breaths per minute, and a temperature of 97.2°F. On ausculatation, her chest was clear bilaterally, and her heart revealed a regular rate with normal S1 and S2, and no murmurs, rubs or gallops. An electrocardiogram was obtained with the computer interpretation of “ACUTE MI” pattern (Figure 1).

What is this patient's diagnosis?

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© 2004 Lippincott Williams & Wilkins, Inc.