Rule Out / Past cases / Myocardial infarction
Rule Out case #2 · GentleMyocardial infarction: a six-clue practice case
Read the clues in order and name the diagnosis as early as you can. Clues move from the patient’s story to the classic findings.
Play it as a game firstGuess before each clue unlocks, then share your score.The clues
Clue 1: A 62-year-old man calls 911 from home at 6 a.m.
Clue 2: He describes heavy pressure in the center of his chest for the last 40 minutes.
Clue 3: The feeling spreads to his left arm and jaw, and he is sweaty and nauseated.
Clue 4: He smokes and has high blood pressure and high cholesterol.
Clue 5: His ECG shows ST-segment elevation in leads II, III and aVF.
Clue 6: His troponin level is elevated.
Show the diagnosis and takeaways
Diagnosis
Myocardial infarction (heart attack)
What gives it away
- Chest pressure that spreads to the arm or jaw with sweating is the classic picture, but women, older adults and people with diabetes often have atypical symptoms.
- ST elevation in II, III and aVF points to an inferior STEMI, usually from the right coronary artery.
- Time is muscle: a STEMI needs the artery reopened fast, ideally with PCI.
Ran as Rule Out #2 (Monday, October 19, 2026).
A new case every day
Rule Out is free and the same for everyone. Start a league with your club or study group and compare scores each week.
Play today’s caseFree question banks