Scenario: A 78-year-old woman arrived at the emergency department (ED) with arm numbness, chest heaviness, and diaphoresis. She had undergone total knee replacement 2 weeks prior, complicated by hematoma and fever, but had no cardiac symptoms after surgery or at discharge. At home, she began feeling chest discomfort 2 days before her ED arrival. Her medical history included hypertension, hyperlipidemia, thrombocytopenia, and asthma. In the ED, her vital signs were heart rate 82/min, respiratory rate 22/min, oxygen saturation 99% on 2 L (nasal cannula), body temperature 101 °F (38 °C), and blood pressure 90/52 mm Hg. Below is the first 12-lead electrocardiogram (ECG) recorded in the ED.

Sinus rhythm at 83/min with inferior wall ST-segment elevation myocardial infarction (STEMI), suspected right ventricular wall involvement; 2 multifocal PVCs.

Myocardial infarction after noncardiac surgery is not uncommon. In patients undergoing total knee or hip replacement, acute MI is a recognized complication...

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