Endocrinology Case Report: Syncope and ST-Elevation

April 27, 2021
Brady Pregerson, MD

Our latest case report from Brady Pregerson, MD, features a middle-aged woman brought to the emergency department by paramedics as a field-activated ST-elevation MI. Check out the EKG and see if you can determine the correct diagnosis.

History: A middle-aged woman with a history of diabetes and hypertension is brought to the emergency department by paramedics as a field-activated ST-elevation MI. They report that about 40 minutes ago she fainted and when she came to she had anxiety, chest pain, and shortness of breath. There was no head injury.

Medics gave aspirin plus 3 doses of nitroglycerin en route without relief.

Exam: On exam, the patient is obese, diaphoretic, and appears very anxious bordering on delirious. She is unable to give much history and is thrashing around.

Vitals: Pulse 131, BP 95/58, pulse ox 98% on oxygen. Lungs are clear and heart is tachycardic with normal heart sounds. Abdomen is rotund and non-tender. Legs have no edema, chords, tenderness, or erythema. Pulses are symmetric.

What is the most likely diagnosis?