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Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chestpain. He was eating lunch when he had sudden onset chest pressure, 9/10, radiating to his back, with sweating and numbness in both hands.
Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chestpain. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Barely any STE, and thus not meeting STEMI criteria.
A 70-year-old man calls 911 after experiencing sudden, severe chestpain. The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! But if there is none - then you are looking at least at an Isolated Posterior STEMI until proven otherwise.
== MY Comment by K EN G RAUER, MD ( 9/17/2020 ): == Todays patient is a previously healthy, 60-something year-old woman who presented with chestpain that began at a reception. Smith for developing Modified Smith-Sgarbossa Criteria for assessing ST-T wave changes in chestpain patients with LBBB. See text ). (
Written by Jesse McLaren, with comments from Smith and Grauer A 60 year old presented with three weeks of intermittent non-exertional chestpain without associated symptoms. A prospective validation of the HEART score for chestpain patients at the emergency department. Lancet 2015 6. Int J Cardiol 2013 2.
Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chestpain. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. Theiling BJ.
Prompt cath is therefore advised if the post-ROSC shows an acute STEMI. The cause of the abnormal baseline deflections seen in Figure-2 is most likely muscle tremor artifact ( See Bouthillet T — ACLS Med Training, Dec, 2015 ). To Emphasize: The phenomenon of T-QRS-D is not needed in today's case to recognize the acute STEMI.
Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chestpain and shortness of breath after finishing a 4-mile run. His symptoms of chestpain and shortness of breath were attributed to an asthma exacerbation during exercise.
Despite the absence of significant coronary stenosis on her post-arrest cath — the ECG in Figure-1 is clearly diagnostic of an extensive anterolateral STEMI ( presumably from acute LAD [ L eft A nterior D escending ] coronary artery occlusion). The rhythm in ECG #1 is regular and supraventricular at a rate of ~75/minute. What is M INOCA?
A 50-something presented with epigastric and chestpain. Saddleback ST Elevation is almost never STEMI 2. Here are other cases of saddleback STE: Is this Saddleback a STEMI?? For M ore on B rugada E CG P atterns : Dr. Smith’s March 26, 2015 post has great illustrations reviewing assessment for a Brugada-2 ECG pattern.
Validation of the Modified Sgarbossa Rule for Diagnosis of STEMI in the Presence of Left Bundle Branch Block. American Heart Journal 170(6):1255-1264; December 2015. After reperfusion, Wellens' waves are evident: Chestpain and LBBB. 0 0 1 41 238 MMRF 1 1 278 14.0 LBBB resolves and there is V1-V3 T-wave inversion.
Other trials that evaluated this subject were the WOEST trial (2013), Pioneer AF-PCI trial (2016), and ISAR-TRIPLE (2015). ACS QID 3103 A 64 year old Caucasian male with a history of extensive tobacco use, hypertension, hyperlipidemia, and obesity presents with acute onset chestpain. Incorrect Answers: A and E. Question 2.
link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chestpain. He described it as "10/10" intensity, radiating across his chest from right to left. This is written by Willy Frick, an amazing cardiology fellow in St.
This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. As it currently stands, an ST/S ratio >15% should raise awareness for new anterior STEMI. Cardiology felt her chestpain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e.
See this case of an awake patient without chestpain but with a CO level of 34%: CO poisoning. Figure-2: Comparison between ST elevation in lead V3 due to a repolarization variant ( TOP from the 4/27/2019 post) vs acute OMI ( BOTTOM from the 9/20/2015 post) , which manifests T-QRS-D ( See text ).
Learning Points: Ectopic atrial rhythm can produce atrial repolarization findings that can be confused for acute ischemia, STEMI, or OMI. See these similar cases: A man in his sixties with chestpain Why is there inferior ST elevation, and would you get posterior leads?
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chestpain, weakness and nausea. Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. What do you see?
Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. Theres inferior STE which meets STEMI criteria, but this is in the context of tall R waves (18mm) and relatively small T waves, and the STD/TWI in aVL is concordant to the negative QRS. This was false positive STEMI with an ECG mimicking OMI.
He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. He contacted EMS due to acute onset chestpain and feeling unwell and fatigued. He subsequently developed worsening chestpain. Pain is improving and ischemic T-wave inversions are no longer present".
He has never been poisoned by the STEMI/NSTEMI paradigm because he has never been to medical school. Case A 76 year old man with chronic hypertension but no history of coronary disease or myocardial infarction presented to the ED with chestpain at 2343. The Queen of Hearts recognizes this as OMI ("STEMI/STEMI Equivalent").
A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chestpain and shortness of breath. She awoke in the morning with sharp chestpain which worsened throughout the morning. As her pain worsened, so did her dyspnea. Also see these posts of Type II STEMI.
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