History: A man in his mid 30’s presents with chest pain and lightheadedness starting around 7 AM central and pleuritic as well as bilateral leg swelling for 4 days. had 3 pneumothoraces on the left side but this does not feel like that. No other complaints.
Exam: Vital signs are normal except for a pulse in the 120. Physical exam is notable for tachycardia, diminished breath sounds on the left and mild symmetric leg edema
An ECG is done
Computer Read: ST at 112, possible RAE
What is the most cause of EKG findings in this patient?
- A) MI
- B) pericarditis
- C) PE
- D) GERD
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ECG interpretation:
Sinus tachycardia with incomplete RBBB and nonspecific ST changes
My ECG interpretation: There is a borderline wide QRS and nonspecific ST changes as well as tachycardia. No PR depression or
What is the most cause of EKG findings in this patient?
- A) MI – can rarely cause pleuritic pain. Rarely causes tachycardia
- B) pericarditis – can cause central pleuritic CP but not typically these ECG changes
- C) PE – CORRECT – there tachycardia and also is actually an incomplete RBBB and nonspecific ST changes
- D) GERD – shouldn’t cause ECG changes but can cause T wave inversion. A diagnosis of exclusion
Outcome: trop 30 then 120, repeat ECG better with HR 90 and similar ST and QRS but read by computer as NSSTE and IRBBB. Started on empiric heparin and once more stable sent to CT which confirmed extensive bilateral PE’s
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