Woman with Pacemaker and New Onset Chest Pain – Clinical Patient Case of the Week

Andrea Eberly, MD, MS, FAAEMClinical Pearls, Emergency Medicine, Family Medicine, Guideline Knowledge Check, Internal Medicine, Nurse Practitioner, Nursing RN/PN, Pediatric Emergency Medicine, Pediatric Medicine, Personal Education, Physician Assistant, Urgent Care

Woman with Pacemaker and New Onset Chest Pain - Acute Coronary Syndromes - Sgarbossa Criteria

Woman with Pacemaker and New Onset Chest Pain - Clinical Patient Case of the Week

Try this free Acute Coronary Syndromes Case Q&A courtesy of Med-Challenger.

This opioid toxicity case comes from our Med-Challenger EM: MyEMCert Review and Answer Resource, part of Med-Challenger's library of board exam review and CME question banks.

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Try this case and test your knowledge of acute coronary syndromes.

A 56-year-old woman presents to you with new-onset chest pain. For the last year, she tells you that she has a pacemaker for "a heart block".

Her vitals are stable, her past medical history is otherwise benign, and cardiac biomarkers are pending. She is visiting from another state, and you are unable to access her prior electrocardiographic ECG results.

ECG is obtained on today's visit (see Figure 1).

Question:

Which statements is correct?

Answer Options:

The catheterization laboratory should not be activated. This is a mimic of ST elevation myocardial infarction (STEMI) with an old left bundle branch block (LBBB) and no signs of acute ischemia.

The catheterization laboratory should be activated. This is an equivalent of ST elevation myocardial infarction (STEMI) with new right bundle branch block.

The catheterization laboratory should be activated. This is an equivalent of ST elevation myocardial infarction (STEMI) with modified Sgarbossa criteria.

The catheterization laboratory should not be activated unless her cardiac biomarkers, when they return, are positive.

See the Answer:

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