Squiggler

Recurrent chest pressure at rest since early morning

The case

57-year-old man. Recurrent chest pressure at rest since early morning

Hypertension and dyslipidaemia. The first pain episode resolved before the ambulance arrived; the pain returned in triage.

On arrival

HR
92
GCS
15
SpO₂ (%)
98
Respiratory rate
18
Temperature (°C)
36.8
Systolic BP (mmHg)
154
Diastolic BP (mmHg)
88

Stage 1 of 1

Pain is present during this recording. The initial high-sensitivity troponin, drawn soon after the first episode, is below the diagnostic threshold.

The tracing for the quiz “Recurrent chest pressure at rest since early morning”.
Twelve-lead recorded on arrival, 25 mm/s, 10 mm/mV. Open this tracing in the studio

Bloods

Initial high-sensitivity troponin
below diagnostic threshold
What is the principal abnormality on this tracing?
What does this pattern indicate in a patient with ongoing pain?
How should the initially low troponin affect interpretation of this ECG?

Diagnosis

Acute coronary syndrome with dynamic ST depression, later confirmed as NSTEMI

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This tracing was generated, not recorded. It opens in the studio with every dial live.

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Discussion

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