Rhythm Nation July 2014

by eabram • July 11, 2014 • 4 Comments

EKG July 2014

45 yo nulliparous F of Hispanic and Caucasian descent pmhx HTN on longstanding ARB p/w left intermittent arm pain x 1 year and 2 days of worsening mid back discomfort and SOB. Pt regularly walks 5 miles a day and has a BMI of 22. Had a benign bladder polyp resected 3 months prior and since then has entered perimenopause with irregular menses. Denies nausea/vomiting/diaphoresis. No other medical problems or environmental exposures.

SH: occasional ETOH (1-2 glasses of wine/wk), no smoking or illicits

FH: one aunt deceased prior to age 50, no known CAD

VS: 152/98, HR 72, RR 16, SaO2 100%, afebrile

PE otherwise unremarkable… except you note the patient seems rather flexible for her age.

EKG as above.

CXR unremarkable.

This patient was sent from her PMD via ambulance for the above abnormal EKG.

What about this EKG is concerning?
After a troponin of 1, Cardiology does a bedside echo and discovers wall-motion abnormalities. The patient is taken to cardiac cath. No plaques are seen, yet stents are placed. What is the location(s) of the stents?
What is this condition called?
What are some of the underlying conditions that may have pre-disposed this patient to her diagnosis?

Now is your chance to figure out what was going on! Best answer to the above 4 questions by noon Friday 7/18/14 wins.

By Dr. Elizabeth Abram

Supervised by Dr. Jennifer Martindale.

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.