Scenario: This 12-lead electrocardiogram (ECG) is from a 75-year-old woman who came to the emergency department with complaints of chest pain. The patient is an active, healthy, retired grandmother whose only medical history is “mild“ hypertension diagnosed 7 years ago, for which she takes metoprolol. The patient has had chest pain “off and on” for the past week, but decided to go to the emergency department because the pain lasted for more than 1 hour, which is longer than usual. Her blood pressure is 110/70 mm HG, and the intensity of her chest pain currently is a 1 out of 10, but was 5 out of 10 two hours previously. Her initial troponin I is 0.045 ng/ml (> 0.04 = positive).

Sinus tachycardia, first degree AV block, premature atrial contraction (7th beat), nonspecific ST, T-wave abnormality in the anterolateral leads V2...

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