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The patient presented due to chestpain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chestpain. It is unclear if the patient was pain free at this time. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder.
The patient presented with chestpain. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chestpain for the ischemia and potential syncope for brugada. Only 5-18% of ED patients with chestpain have a myocardial infarction of any kind. Bradycardia.
All of the patients presented with chestpain , and they are all in triage. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI?
It was from a patient with chestpain: Note the obvious Brugada pattern. The elevated troponin was attributed to either type 2 MI or to non-MI acute myocardial injury. There is no further workup at this time. Smith: Here is a case that was just texted to me today from a former resident. This patient ruled out for MI.
She did notice something slightly wrong subjectively, but had no palpitations, chestpain, or SOB, or any other symptom. Baseline bradycardia in endurance athletes limits the use of ß-blockers. This middle-aged patient has a remote history of cardiac surgery as a young child for a "heart murmur". She was on no medications.
J Electrocardiology 45 (2012):433-442. Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If The patient denied any chestpain whatsoever, and a troponin at zero and 2 hours were both undetectable. Bayes de Luna, A et al.
Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. Bradycardia and heart block are very common in RCA OMI. He had no chestpain, dyspnea, or any other anginal equivalent, and his vital signs were normal. He told the patient this horrible news. link] Mostofsky, E., Maclure, M.,
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