Cardiology Case Report: Generalized Weakness and Dyspnea

Author(s):

This case report from Brady Pregerson, MD, features a woman in her mid-60s presenting to the ER with generalized weakness and dyspnea. Can you determine the correct diagnosis?

History:

A patient in their mid-60s with a history of COPD on home oxygen, recurrent pyelonephritis, and GERD on a PPI presents to the ER with generalized weakness and her baseline level of dyspnea. She denies any current diarrhea, dysuria, fever, chest pain, or other complaints.

Exam:

Vital signs are normal. The physical exam is normal except for bilaterally diminished breath sounds consistent with advanced COPD.

Patient ECG:

Computer Read: NSR 94, ST deviation and moderate T wave abnormality, consider inferior ischemia
Credit: Brady Pregerson, MD

What is the most likely cause of the ECG findings in this patient?