A 42-year-old man is conveyed to the ED via private vehicle with a 1-week history shortness of breath and bilateral leg swelling. Past medical history is negative; he takes no medications. He injects heroin, last 2 hours prior to arrival, and smokes tobacco.
On exam, blood pressure is 112/73 mm Hg, pulse 125 bpm, respirations 20, temperature 35.9. Chest is clear and heart sounds normal. Mild symmetrical pitting edema is noted in both legs up to the knees. Pulses are intact.
Pulse oximetry registers an oxygen saturation of 78% on 5 liters of oxygen per minute via nasal cannulae.
The attached ECG and CxR were obtained. (Click on image to enlarge)
1. Interpret the ECG?
2. List 3 of the most likely diagnoses?
3. What is the most appropriate management for this patient?
Please post your answer in the “reply box” or click on the “comments” link You will not see your answer post until next week when all of the submitted answers will be posted. Good luck!
Tracings is a learning module involving actual cases of patients and their ECGs that present to the Emergency Department. Topics are derived from the EM Model for Resident Education. Cases are prepared by Dr. William Berk.
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