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ACCP-SEEK Board Review Question of the Month |

Abnormal ECG in Man Admitted to ICU With Chest Pain and Irregular Pulse*

Joseph E. Parrillo
Author and Funding Information

*From the ACCP-SEEK program, reprinted with permission. Items are selected by Department Editors Richard S. Irwin, MD, FCCP, and John G. Weg, MD, FCCP. For additional information, phone 1-847-498-1400.

Correspondence to: Joseph E. Parrillo, MD, FCCP, Cooper University Hospital, One Cooper Plaza, Suite 404, Camden, NJ 08103; e-mail: Parrillo-Joseph@cooperhealth.edu



Chest. 2004;125(2):775-776. doi:10.1378/chest.125.2.775
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Extract

A 73-year-old man enters the ICU with chest pain and an irregular pulse. The patient has a long history of coronary artery disease, with a myocardial infarction 10 years ago and coronary artery bypass graft surgery performed 7 years ago. He is known to have a left bundle-branch block on his ECG since his coronary artery bypass graft surgery. In the past 7 years, he has been asymptomatic. He has been taking aspirin for years.

This morning he awoke with substernal chest pressure that lasted < 10 min. Although the pain was similar to that of his myocardial infarction, he graded it only 3 on a scale of 10 in intensity. The patient came to the emergency department, where he was pain free. Physical examination revealed a pulse of 70 beats/min and irregular, and a BP of 130/80 mm Hg. The rest of his physical examination was normal. His ECG is shown (Fig 1 ). Blood is drawn for laboratory tests, and he is transferred to the ICU. Initial management of this patient should include which of the following?

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