A man in his 70s with chest pain during a bike ride

Case written and submitted by Ryan Barnicle MD, with edits by Pendell MeyersWhile vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding. It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. It was radiating to his bilateral upper arms. It was associated with nausea but he denied dyspnea, dizziness, and headache.He explained that he had the same chest pain the day prior as well, on and off. That episode started while climbing a long set of stairs from the beach to the parking lot. His pain radiated to his shoulders throughout the evening and the night but it did not prompt him to seek medical attention.The patient stated he had a long history of well-controlled hypertension for which he was compliant with his ACE-inhibitor. He was also treated for erectile dysfunction but had not taken any medications recently. He had no prior MI and recalls a “negative” stress test in the recent years.His vital signs on arrival were HR 77, BP 148/95, RR 16, SpO2 95%. He was in obvious discomfort.Below was his first ECG, obtained within minutes of arrival.What do you think?Meyers comment: Ryan texted me this ECG with no information and my response was " Tough one. I'm worried about inferior posterior OMI but not convinced yet. Would get serial...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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