90 y/o woman h/o sick sinus syndrome, AF, and a pacemaker presents with atypical CP. Troponins are negative, CTPA is negative for PE. She denies palpitations, shock-like sensations, or chest wall contractions. Palpated HR corresponds with QRS complexes on the monitor.
What's going on with this pacemaker? Is the malfunction the cause of her symptoms?
HPI: 50 y/o male with hx of COPD, heroin use, and recently diagnosed cor pulmonale presents with 3 weeks of lower extremity edema. No chest pain, shortness of breath, or palpitations. An EKG is obtained in the emergency department.
HPI: 57 y/o woman with remote hx of CABG/PCI presents with 2 hrs of 6-10/10 substernal chest tightness and SOB. No recent cardiac events/complaints. Initial troponin is 1.48.
Question: Is this patient experiencing a STEMI despite the lack of ST elevations ≥1mm? How would you diagnose this and explain to your cardiology consultants?