Case 107


A 68-year-old male was admitted at the emergency department complaining of sudden intermittent episodes of intense uneasiness, blurred vision and sense of imminent death which had begun 10 days before, lasted only a few seconds and recurred about 6 times a day. The patient reported having had a similar episode 6 months before. He had previous history of hypertension, Chagas disease, severe persistent asthma and diabetes mellitus and was taking Budesonide + Formoterol 400mcg+12mcg twice a day, Montelukast 10mg, Salbutamol 100mcg/puff as a rescue medication, Hydrochlorothiazide 25mg, Glibenclamide (Glyburide) 5mg, Losartan 50mg twice a day and Metformin 850mg. On physical examination it was observed: BP: 160/90 mmHg, PR: 95/min, RR: 20/min, normal breath sounds, regular heart rhythm and rate, normal heart sounds without murmurs, a soft and non-tender abdomen and absence of peripheral edema. The patient was monitored and evaluated with serial ECG (Images 1 and 2) and chest radiography (Image 3). He then experienced another acute episode of discomfort with simultaneous ECG recording (Image 4).


Based on the clinical history and images provided, one can assume that:

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