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A 50-something man presented in shock with severe chestpain. Here is his ED ECG: There is bradycardia with a junctional escape. Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The November 27, 2021 post ( LA-RA reversal ). He appeared gray in color, with cool skin.
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chestpain for 3 hours prior to arrival. 2021 Dec 7;10(23):e022866. Epub 2021 Nov 15. Triage EKG: What do you think? J Am Heart Assoc. 121.022866.
The rhythm is sinus bradycardia at a rate just over 50/minute. Although difficult to measure ( because of marked overlap of the QRS in multiple chest leads ) — there appears to be greatly increased QRS amplitude, consistent with voltage for LVH. The November 27, 2021 post ( LA-RA reversal ).
She was hemodynamically stable — and did not have chestpain, lightheadedness or syncope. Even if we stopped here — We could conclude the following: There is marked bradycardia in today's rhythm ( ie, Heart rate in the low 30s ). QUESTIONS: HOW would you interpret the rhythm in Figure-1 ? Is this " high -grade" AV block?
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.
He denied any chestpain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. They recommended repeating his ECG and awaiting troponin since the patient did not have any chestpain. He complained of generalized weakness and left lower extremity numbness. What is it? Activate the Cath Lab?
That said — obvious findings include: i ) Marked bradycardia! — The October 25, 2021 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) reviews my approach to another case of a Dual-Level Wenckebach block. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study. be regular! —
This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chestpain. Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. J of Emerg Med 2021. What do you think?
There was no chestpain. For example — bradycardia and AV conduction disturbances are not uncommon with Hyperkalemia , with these conduction disturbances most often resolving once serum K+ is corrected. Figure-3: Diagnostic considerations for a patient who presents in AV block ( adapted from Mangi et al — StatPearls, 2021 ).
His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. 2021 Sep;49(6):488-500. In a patient with ongoing, severe chestpain — the subtle-but-real ST-T wave changes are "dynamic" indication of an ongoing acute cardiac event — therefore prompting the need for cardiac cath! Aslanger EK, Meyers HP, Smith SW.
Smith and Myers found that in otherwise classic Wellens syndrome – that is, prior anginal chestpain that resolves with subsequent dynamic T wave inversions on the ECG – even the T waves of LBBB behave similarly. [2] 2] Although the clinical context in today’s case does not fit these descriptors for Type I OMI (e.g. 6] Tabrizi, F.,
And she does not know that this is an overdose; she thinks it is a patient with chestpain!! Details of management extend beyond the scope of this ECG Blog — with reviews by Atemnkeng at al ( J Med Cases 12[9]:373-376, 2021 ) and Chakraborty & Hamilton ( StatPearls, 2023 ) available for interested readers.
To improve visualization — I've digitized the original ECG using PMcardio ) MY Thoughts on the ECG in Figure-1: This is a challenging tracing to interpret — because there is marked bradycardia with an irregular rhythm and a change in QRS morphology. Figure-1: The initial ECG in today's case. ( The QRS complex is wide ( ie, >0.10
days of chestpain that started as substernal and crushing in nature awakening him from sleep and occasionally traveling to right side of neck. The pain was described as constant, worse with deep inspiration and physical activity, sometimes sharp. 2021 Aug 10;144(6):e123-e135. Epub 2021 Jul 7. Epub 2021 May 20.
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