A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.
According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation. She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest. Today she awoke with substernal chest pain that never resolved and continued in the emergency department. She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.
BP 127/89 HR 76 RR 20 O2 sat 100% on 2L NC Temp 99.3
Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
2+ pulses in her extremities, no edema
ECG is shown (No prior ECG for comparison)…..