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Symptoms: Sinus Bradycardia with ST Segment Elevation

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

Cases in Electrocardiography

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; 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. 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 56 year-old woman with a history of hypertension and diabetes mellitus presented to the ED with chest pain. She also reported nausea, diaphoresis, and weakness. Initial examination revealed that she was diaphoretic with pale skin and in mild respiratory distress.

Vital signs included blood pressure 90/60 mm Hg, pulse 60 bpm, and respiratory rate 32 breaths per minute. Cardiopulmonary examination was significant for rales in the lower lung fields. Cardiac monitor in lead II demonstrated sinus bradycardia with ST segment elevation. The patient then lost consciousness, and the cardiac monitor revealed ventricular fibrillation (Figure 1A). Immediate defibrillation at 200 joules restored a pulse with a rate of approximately 140 bpm. Blood pressure was measured at 170/90 mm Hg. The monitor showed a regular, wide complex tachycardia (Figure 1B). The patient immediately regained consciousness, noting no complaints other than nausea, weakness, and chest pain.

What is the patient's diagnosis?

Figure 1

Figure 1

© 2004 Lippincott Williams & Wilkins, Inc.