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Course: Ominous Electrocardiogram Changes in a Man With Distal Extremity Weakness

CME Credits: 1.00

Released: 2023-10-16

A man in his 30s presented to the emergency department with a sudden onset of distal extremity weakness after waking up 10 hours prior. He reported that he was unable to get up, with no strength to lift his neck, but could move in a plane and had vomited 4 times. He denied recently having poor appetite or diarrhea and was not currently taking medication. On examination, the patient’s blood pressure was 114/83 mm Hg and heart rate was 140 beats per minute. Urgent echocardiography results showed no significant abnormalities. Laboratory tests revealed a cardiac troponin T (cTnT) level of 0.14 ng/mL (reference range, <0.017 ng/mL; to convert to ?g/L, multiply by 1.0) and a potassium level of 1.4 mEq/L (reference range, 3.5-5.5 mEq/L; to convert to mmol/L, multiply by 1.0). An electrocardiogram (ECG) obtained on admission showed sinus tachycardia with widespread ST-segment depression in more than 6 surface leads and ST-segment elevation in lead aVR (, A).


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