Chest Pain Numbs Holiday Cheer

ANSWER

The correct interpretation includes normal sinus rhythm and right atrial enlargement. The latter is suggested by tall P waves in leads II, III, and aVF (typically ≥ 2.5 mm), which may be caused by pressure or volume overload of the right atrium or by conditions causing pulmonary hypertension.

Given this patient’s presentation of right-side chest pain with a history of COPD, smoking, palpable left saphenous vein, and right atrial enlargement, a chest CT was performed. It confirmed the suspicion of a pulmonary embolus.