12-20-2008, 07:34 PM
A 64-year-old woman is evaluated in the emergency department 6 hours after the onset of severe crushing chest pain associated with diaphoresis, nausea, and vomiting. Her medical history is significant only for mild hyperlipidemia; her medications include atorvastatin and aspirin.
Her blood pressure is 140/88 mm Hg, and her pulse rate is 88/min. The lungs are clear; she has no murmurs; examination of the abdomen and extremities is normal. Electrocardiogram shows a 3-mm ST-segment elevation in leads II, III, and aVF, with occasional premature ventricular contractions. The hospital does not have cardiac catheterization facilities, and the patient is therefore given fibrinolytic therapy and transferred to another hospital's intensive care unit. In transit, the chest pain resolves. The patient has two episodes of 6- to 10-beat ventricular tachycardia and stable hemodynamic parameters. Electrocardiogram now shows a
Her blood pressure is 140/88 mm Hg, and her pulse rate is 88/min. The lungs are clear; she has no murmurs; examination of the abdomen and extremities is normal. Electrocardiogram shows a 3-mm ST-segment elevation in leads II, III, and aVF, with occasional premature ventricular contractions. The hospital does not have cardiac catheterization facilities, and the patient is therefore given fibrinolytic therapy and transferred to another hospital's intensive care unit. In transit, the chest pain resolves. The patient has two episodes of 6- to 10-beat ventricular tachycardia and stable hemodynamic parameters. Electrocardiogram now shows a