Scenario: A 69-year-old man came to the emergency department with developing dyspnea and syncope after gardening. His cardiovascular risk factors included older age (>65 years), male sex, hypertension, hypercholesterolemia, obesity, and a 35-pack-year smoking history. He had a nondiagnostic resting 12-lead electrocardiogram (ECG) at triage, no arrhythmic events on 5-lead telemetry, and a nondiagnostic change in serial high-sensitivity troponin levels (0 hour: 9 ng/dL, 3 hour: 11 ng/dL; normal: <14 ng/dL), which collectively ruled out acute coronary syndrome. He was discharged home with an appointment 3 days later for cardiology follow-up with an exercise nuclear stress test. Before that test, his 12-lead ECG was normal (no ST-segment or T-wave changes). After 13 minutes of exercise, he achieved 9.3 metabolic equivalents with a diagnostic cardiac workload but had to stop exercising because of 7/10 chest pain. The nurse noted he was pale and assisted him to the stretcher, with the...
Skip Nav Destination
ECG Puzzler| September 01 2023
Acute Symptom Onset During Exercise Stress Testing
Dillon J. Dzikowicz, PhD, RN, PCCN;
Teri M. Kozik, PhD, RN, CNS;
Am J Crit Care (2023) 32 (5): 391–392.
Dillon J. Dzikowicz, Teri M. Kozik, Michele M. Pelter; Acute Symptom Onset During Exercise Stress Testing. Am J Crit Care 1 September 2023; 32 (5): 391–392. doi: https://doi.org/10.4037/ajcc2023381
Download citation file:
Don't already have an account? Register