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BACKGROUND
A 68-year-old woman of Persian
descent presents to the emergency department complaining of intermittent
substernal chest pressure and progressive dyspnea for 4 days. She denies
having similar symptoms in the past. Today, her symptoms worsened
significantly, and she is now dyspneic at rest. Her chest pressure is
constant, moderate in intensity, nonradiating, nonpleuritic, and
nonpositional. She has no paroxysmal nocturnal dyspnea, orthopnea, or
lower-extremity edema. She denies long-distance travel, recent surgery,
or immobilization. Her medical history is significant for diabetes
mellitus for which she takes an oral hypoglycemic agent.
During triage, the patient is awake, calm, and alert. She has a
respiratory rate of 30 breaths per minute, a heart rate of 40 bpm, a
blood pressure of 138/76 mm Hg, and an oxygen saturation of 82% on room
air. The patient was immediately given oxygen by means of a
nonrebreather face mask and attached to a cardiac monitor with
continuous pulse oximetry. An intravenous line is started, external
cardiac-pacing pads are placed on her chest, and a cardiac resuscitation
cart is brought to the bedside. An initial rhythm strip (see Image 1) is
obtained.
What are the clinically significant findings, and how is the condition
treated? |
Hint
Consider a conduction abnormality. |
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Authors:
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Craig Goolsby, MD, UCLA/Olive
View-UCLA Medical Center Residency, Department of Emergency Medicine,
Olive View - UCLA Medical Center
Erik Schraga, MD, UCLA/Olive View-UCLA Medical Center Residency,
Department of Emergency Medicine, Olive View - UCLA Medical Center
Rick G. Kulkarni, MD, Assistant Professor, Yale School of Medicine,
Section of Emergency Medicine, Department of Surgery, Attending
Physician, Medical Director, Department of Emergency Services, Yale-New
Haven Hospital |
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eMedicine Editor:
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John Vozenilek, MD,
Division of Emergency Medicine, Evanston Northwestern Healthcare |
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