Remove 2018 Remove Chest Pain Remove Dysrhythmia
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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

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A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?

Dr. Smith's ECG Blog

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. If you don't know what the dysrhythmia is, then try procainamide. What to do now?

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An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. See this post: Classic Evolution of Wellens' T-waves over 26 hours This is one patient, with ECG recorded at time zero after pain resolution, then at time 2 hours, then at time 9 hours. Circ Cardiovasc Interv.

SCAD 52
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A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. There were no dysrhythmias on cardiac monitor during observation. See below for PM Cardio digitized version of this.

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Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

It was from a patient with chest pain: 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.