JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
ECG CASE OF THE MONTH
Epigastric and Back Pain and High Blood Pressure in a 63-Year-Old Man
D. Luke Glancy, MD
A 63-year-old obese man with long-standing high blood pressure, an old cerebrovascular accident, and near blindness due to an old eye injury came to the emergency department at 2 a.m. because of acute epigastric and thoracic back pain. Exam revealed a distended, tympanitic abdomen without tenderness. Bowel sounds were sparse. Crackles were heard at both long bases, and there was an occasional wheeze. Heart rate was 80 beats per minute, and blood pressure was 245/150 mmHg. Carotid, radial, and femoral pulses were strong and equal bilaterally. Neck veins were normal. Therewas no cardiomegaly by physical exam, and heart sounds were normal. A squint and oscillating nystagmus were noted and apparently were the result of his old ocular trauma. An electrocardiogram (ECG) was recorded (Figure).
Figure: ECG recorded in the emergency department in a 63-year-old man with high blood pressure, epigastric pain, and back pain. See text for explication.
What is your diagnosis? Explication is on p. 144 .
J La State Med Soc VOL 169 SEPTEMBER/OCTOBER 2017 143
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