A man in his 50s with hypoxemic respiratory failure from COVID pneumonia develops chest pain

Submitted by anonymous, written by Parker Hambright, MD, peer reviewed by Meyers, Smith, McLarenA man in his 50s with a past medical history of hypertension and tobacco use disorder, who tested COVID positive 11 days prior, presented to the emergency department with worsening shortness of breath over several days. He was tachypneic and hypoxemic down to as low as 44% with reportedly good SpO2 waveform before EMS applied noninvasive ventilation with improvement to 85-89%. Although history was limited by extremis, the report is that there was no chest pain at initial presentation, only shortness of breath.Here is his ECG on arrival, Day 1 around 0530:What do you think?I see some small ST depression in V3-V6, II, III, aVF, and very small reciprocal STE in aVR. In the context of known covid with severe hypoxemia and respiratory distress, I would likely feel that this ECG most likely represents subendocardial ischemia, which is well explained by hypoxemia and respiratory distress.Evaluation was remarkable for acute hypoxemic respiratory failure secondary to COVID-pneumonia and the patient was initiated on BiPAP and admitted to the ICU. It seems that no troponin was ordered so far. While boarding in the emergency department awaiting an ICU bed, the patient developed acute onset substernal and left sided chest pain, without any worsening of his shortness of breath or any escalation in his oxygenation/ventilation parameters or work of breathing.  A repeat ECG was obtained:ECG 2 ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs