Treating her well

Clinical introduction

A 44-year-old woman presents pain free to our ED after experiencing 45 min of tightening of the chest with radiation to her left arm, diaphoresis and nausea. Her vital signs are normal except for her high BP, which is 180/110. She reports recurrent episodes of chest pain in the past 1.5 weeks, unrelated to exercise. She visited a general practitioner who prescribed pain medication and treated her new-onset hypertension. Besides the recently found hypertension, heavy smoking is her only other traditional risk factor for cardiovascular disease.

Question

What finding on figure 1 should make you concerned?

Figure 1

Initial ECG.

The U-wave in the precordial leads

The biphasic P-wave in lead I

The negative T-waves in aVR as well as aVL

The biphasic T-waves in V2 and V3

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