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Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chestpain. The primary care physician there evaluated this patient and deemed the chestpain to be due to gastrointestinal causes. Clinical Cardiology 2019. No troponins were measured!
Written by Jesse McLaren Two patients in their 70s presented to the ED with chestpain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Do either, both, or neither have occlusion MI? Vitals were normal.
Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiacarrest. BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Figure-1: The initial ECG in today's case — obtained after successful resuscitation from cardiacarrest. ( No CP ( C hest P ain ).
The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiacarrest. I i llustrate the ECG finding of T-QRS-D below in Figure-3 , which I've excerpted from My Comment in the November 14, 2019 post in Dr. Smith's ECG Blog. Should you activate the cath lab?
Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiacarrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). Having looked for negative U waves in patients with chestpain over a period of decades — I'll emphasize that this is not a common finding.
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chestpain to Dr. McLaren. Am J Med 2019, 132(5):622-630. American Journal of Medicine 132(5):622-630; May 2019.
This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chestpain. A mid 60s woman with history of hypertension, hyperlipidemia, and GERD called 911 for chestpain. It is also NOT the clinical scenario of takotsubo (a week of intermittent chestpain).
If a patient presents with chestpain and a normal heart rate, or with shockable cardiacarrest, then ischemic appearing ST elevation is STEMI until proven otherwise. It is important to remember that not every acute MI with ST elevation is the result of acute coronary occlusio n. Clinical Context is everything !
No more abnormal U-waves == MY Comment, by K EN G RAUER, MD ( 11/18/2019 ): == LOTS of great points regarding use of the ECG in association with electrolyte abnormalities. This is often quite challenging to recognize — but the finding of negative U waves in a patient with chestpain is highly suggestive of ischemia !
ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of ChestPain 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?
I’ve previously discussed clinical application of the Mirror Test on several occasions ( SEE My Comment at the bottom of the page in both the September 13, 2020 post and the February 16, 2019 post in Dr. Smith’s ECG Blog ).
A patient had a cardiacarrest with ventricular fibrillation and was successfully defibrillated. Coronary Angiography after CardiacArrest without ST-Segment Elevation. N Engl J Med [Internet] 2019;Available from: [link] Should all patients with shockable arrest be taken to angiography regardless of STEMI or No STEMI?
He woke up alert and with chestpain which he also had experienced intermittently over the previous few days. The history in today's case with sudden loss of consciousness followed by chestpain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?
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. This ECG was sent from South Asia. Here is the ECG: What do you think? I frankly did not know what to think.
He did not have chestpain. Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management CardiacArrest. Chestpain in high risk patient. Here is his triage ECG: What do you think? What does the ECG show? Also see the bizarre Bigeminy. Is it STEMI?
Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiacarrest, cardiogenic shock or impending shock. Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with ChestPain?
The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chestpain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.
Unfortunately — the patient abruptly developed hypoxemia, followed by cardiacarrest with PEA. It was thought that this action precipitated the patient's desaturation, and led to his cardiacarrest. The plan was to proceed as soon as possible with aortic valve replacement. He could not be resuscitated.
Although in the context of chestpain such ST depression would be all but diagnostic of posterior OMI, one should make no conclusions in such an unusual case. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. In all leads, there is a 2nd wave after the initial QRS.
It was from a patient with chestpain: Note the obvious Brugada pattern. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. The elevated troponin was attributed to either type 2 MI or to non-MI acute myocardial injury. This patient ruled out for MI.
This patient had many complaints including chestpain. Comment by K EN G RAUER, MD ( 2/11 /2023 ): = Today’s case is from a patient with “many complaints”, including chestpain — and, an ECG that raised concern about acute anterior OMI. The computer called this Acute STEMI What do you think? The ioninzed calcium was 6.5
Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiacarrest in sleep. The patient denied any chestpain whatsoever, and a troponin at zero and 2 hours were both undetectable. Annals of Noninvasive Electrocardiology 2019.
A middle-age woman with no previous cardiac history called 911 for chestpain. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiacarrest resuscitation. This was her prehospital ECG: What do you think? DOI: 10.1016/j.resuscitation.2025.110515
Written by Pendell Meyers An adult man presented with acute chestpain. Acute chestpain, right bundle branch block, no STEMI criteria, and negative initial troponin. What is the Diagnosis in this 70-something with ChestPain? 68 minutes with chest compressions, full recovery.
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