امرأة عمرها ٧٠ سنة، مصابة بالسكري من ٢٠ سنة وارتفاع الضغط، تشتكي من تعب شديد مفاجئ وغثيان وضيق نفس بسيط منذ الصباح، بدون ألم صدري. الضغط ١٠٤/٦٦، النبض ١٠٨، التشبع ٩٤٪، والسكر ٢١٠. ما أول إجراء؟

A 70-year-old woman with diabetes for 20 years and hypertension reports sudden severe fatigue, nausea and mild breathlessness since the morning, without chest pain. BP 104/66, HR 108, SpO2 94%, glucose 210 mg/dL. What is the first action?

1. Request liver function tests to exclude a GI cause
2. Encourage rest and reassess in an hour
3. Check her glucose, then give an antiemetic
4. Obtain a 12-lead ECG within 10 minutes

Answer: D) Obtain a 12-lead ECG within 10 minutes. Women, older adults and people with diabetes often present with atypical MI symptoms such as fatigue, nausea and dyspnoea without pain. An ECG within 10 minutes is the first step.