A deadly alcohol binge: a man in his 30s with chest pain and initial high sensitivity troponin I within normal limits

Submitted and written by Emergency Physician Dr. Arjun J V, with some minimal edits by Smith and MeyersA man in his 30s was rushed into our ED on a Sunday morning with continuous chest pain for 2 hours. The patient was drowsy but following simple commands and was pointing to his left chest where it hurt with a single finger. He said the pain started after he tried to vomit forcefully. He also had the odor of alcohol to his breath. The patient voluntarily told the team he had half a bottle of whiskey the previous night and he was uncomfortable ever since he woke up. He did, however, consume alcohol on a regular basis but never at such high amounts.The information about the binge drinking made the whole team take a non-urgent approach towards the patient. We took our time to settle the patient into bed, secure IV access and by the time we had a cardiac tracing on the monitor, we had the following vitals: HR - 120 bpm; BP - 100/60 mm Hg; SpO2 - 95% on RA. The patient was given antacids, started on IV fluids including thiamine before getting a 12-lead ECG within 10 minutes of arrival. Our differentials included: ACS, Boerhaave syndrome, Pneumothorax, Pancreatitis& GERD.The monitor showed upsloping ST segments in II. A 12-lead ECG was immediately obtained: Here is the same image processed by " PMcardio " app, which so far seems quite good at improving image quality and resolution:Interpretation: Sinus tachycardia, with RBBB and LAFB. Concordant STE in V2, V3, I, and aVL. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs