76 year old female sent to the ED by her PCP for evaluation | Figure 1

AboveTheCarina

Physician Assistant

76 year old female sent to the ED by her PCP for evaluation of x14 hours of abdominal pain and back/shoulder pain. On initial evaluation, EKG (#1) showed nonspecific ST changes without STEMI findings, but there was concern her back and shoulder pain could be an anginal equivalent. On reevaluation, patient reported bilateral shoulder pain that was 9/10. Serial EKG (#2) was obtained 1.5 hours later and cardiac enzymes came back showing CK of 2203, CK-MB of 424.9, and troponin of 27.8. STEMI was not called, but cardiology recommended STEMI activation and patient was taken to cath lab.

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