Scenario: An 87-year-old woman with a history of atrial fibrillation, hypertension, and hyperlipidemia came to the emergency department with substernal chest pain that was not relieved with nitroglycerin. She was found to be in atrial fibrillation with rapid ventricular response and had dynamic troponin levels that were concerning for myocardial infarction. Left-sided cardiac catheterization revealed severe coronary disease with about 80% occlusion of the left main and left anterior descending coronary arteries; however, percutaneous coronary intervention (PCI) was not done because of the patient’s hemodynamic instability. After the catheterization, she continued to have substernal chest pain for 2 days and was taken back for emergent PCI with temporary mechanical ventricular support. Two drug-eluting stents were placed. Her bedside electrocardiography (ECG) strip after the emergent PCI is shown here.

Atrial bigeminy with a sinus rate of 35 beats per minute and right bundle branch block (RBBB).

This patient exhibited multiple...

You do not currently have access to this content.