You are here

Article Text

Article menu
Download PDFPDF
Image Challenge
Treating her well
  1. Joris M G Theunissen1,
  2. Heleen lameijer2
  1. 1 Department of Emergency Medicine, Medical Center Leeuwarden, Leeuwarden, The Netherlands
  2. 2 Department of Emergency Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  1. Correspondence to Dr Heleen lameijer, Department of Emergency Medicine University Medical Centre Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands; h.lameijer{at}umcg.nl

Abstract

Clinical introduction A 44-year-old woman presents pain free to our ED after experiencing 45 min of tightening of the chest with radiation to her left arm, diaphoresis and nausea. Her vital signs are normal except for her high BP, which is 180/110. She reports recurrent episodes of chest pain in the past 1.5 weeks, unrelated to exercise. She visited a general practitioner who prescribed pain medication and treated her new-onset hypertension. Besides the recently found hypertension, heavy smoking is her only other traditional risk factor for cardiovascular disease.

Question What finding on figure 1 should make you concerned?

Figure 1
Figure 1

Initial ECG.

  1. The U-wave in the precordial leads

  2. The biphasic P-wave in lead I

  3. The negative T-waves in aVR as well as aVL

  4. The biphasic T-waves in V2 and V3

  • wellens sign
  • coronary artery disease
  • acute myocardial infarction
  • ECG

https://doi.org/10.1136/emermed-2017-206967

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.