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A 63-year-old man with fatigue, mild dyspnea and cough for two days

Acute ECG Challenge - Episode 4

04/11/2020 18:00 04/11/2020 18:30 Europe/Paris A 63-year-old man with fatigue, mild dyspnea and cough for two days DD/MM/YYYY


The case


  • No smoking
  • Hypertension
  • No diabetes

For two days:

  • fatigue
  • weakness in both arms
  • light dyspnea
  • non-productive cough
  • denies chest pain
  • no fever


  • Pale, greyish, cold wet extremities
  • BP 168/99 P 79
  • 36.5 °C
  • Respiratory rate: 12-20
  • sO₂ 80 % rasing to 100% under 15L/min O₂
  • Heart: regular, no murmur
  • Lungs: bilateral basal inspiratory crepitations

Pre-hospital ECG:

  • ST-elevation V1-V4
  • Urgent transfer for primary PCI

Watch how Dr. Alberto Somaschini is reviewing the case after he discovered it with Prof. Christiaan Vrints.

The Challengee: Dr. Alberto Somaschini, Italy

Alberto Somaschini.jpg

I really enjoyed this ECG challenge!

It was a perfect example of how an initially simple clinical case might turn in a more complicated one in a very short time.In these situations - despite the rush - it is mandatory to keep a systematic approach to the ECG, as Prof. Vrints reminded us. I' m looking forward to seeing the next case.