A 52-year-old female with a history of multiple sclerosis presents to the emergency department for generalized weakness and trouble swallowing that has gradually worsened over the past six days. She denies any syncope, palpitations, chest pain, dyspnea, fever, cough, sore throat or other complaints.
Exam: Vital signs are normal except for a pulse of 115 beats per minute. Blood pressure is 140/88. Ear nose and throat exam is unremarkable and she is handling secretions without difficulty. The rest of her physical exam is otherwise non focal.
Initial differential diagnosis: Tachydysrhythmia, electrolyte abnormality, pulmonary embolism, acute coronary syndrome.
EKG read (see image on the right for initial EKG):
1. Sinus tachycardia
2. Right atrial enlargement
3. ST & T wave abnormality, consider inferior ischemia
4. ST & T wave abnormality, consider anterolateral ischemia
5. Abnormal ECG
Do you agree with the EKG read? What should you do next?
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