A 65-Year-Old Man with Epigastric Pain, Dyspnea, and a ‘Clammy’ Feeling

Figure 1.

Case

The patient is a 65-year-old man with symptoms of epigastric pain over the last 2 hours, with some dyspnea and a “clammy feeling.” He has a history of GERD and has used both an oral antacid and omeprazole within the past hours without relief.

Upon exam, you find:

• General: Alert and oriented. Skin cool and moist
• Lungs: CTAB
• Cardiovascular: Regular rate and rhythm without f/r/g
• Abdomen: Soft and nontender without rigidity, rebound, or guarding. No epigastric pain with palpation
• Extremities: No pain or swelling of the LE, pulses equal

View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.