ECGs in the ED

摘要

A 15-year-old boy presents to the emergency department (ED) for evaluation of chest pain. He has a history of hypertrophic cardiomyopathy, and had a transvenous implantable cardioverter-defibrillator placed 2 years ago. The chest pain started 3 hours prior to arrival to the ED. The pain is described as sharp and along the left sternal border. When he coughs or pushes on the area, the pain is worse. There is no associated shortness of breath, palpitations, or dizziness. There has been no trauma to the area. He denies headache, nausea, fever, or rash. There has been no erythema, swelling, or discharge at the site of the device pocket in the left clavicular area. The past medical history is significant for hypertrophic cardiomyopathy diagnosed at 6 years of age. The device was implanted following a syncopal event. Other risks factors included a family history of sudden death and a septal wall thickness >3 cm. His only medication is metoprolol, and he reports compliance with the prescribed dose. He has no known drug allergies. The family history is significant for sudden death due to hypertrophic cardiomyopathy in a maternal uncle at 26 years of age. The patient's mother has hypertrophic cardiomyopathy and is treated with a beta blocker. The patient has one healthy sister who has had a normal echocardiogram. He is a high school sophomore and denies illicit drug use.