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Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain. His father had a minor heartattack at the age of 63. With a negative initial troponin, this gives him a HEART score of 4. If we thought about ACS, we brought them in. AEM June 2022.
He reportedly told his family "I think I'm having a heartattack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. CPR was initiated immediately. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation.
He stated it was similar to prior heartattacks. About an hour later, he was then found on the floor in cardiac arrest in the ED. ST depression maximal in V1-V4, in the context of ACS symptoms and unexplained by QRS abnormality or tachydysrhythmia, should be considered posterior OMI until proven otherwise.
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