Remove Angioplasty Remove Chest Pain Remove Echocardiogram
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A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." The initial troponin I was elevated at 0.75

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An elderly male with shortness of breath

Dr. Smith's ECG Blog

He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. First troponin I returns at 48 ng/L ECG 5 143 min No significant change ECG 6 261 min Same hs Troponin I profile (peaked at 1849): Formal Echocardiogram SUMMARY The estimated left ventricular ejection fraction is 74 %.

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First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

This male in his 40's had been having intermittent chest pain for one week. He awoke from sleep with crushing central chest pain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric. The peak troponin I was 0.364 ng/ml.

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Why you should use the Queen of Hearts and record serial ECGs more often. If you wait for troponin.

Dr. Smith's ECG Blog

He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. Successful primary angioplasty of the mid-circumflex artery towards the main marginal branch with the implantation of a drug-eluting stent. You must record frequent serial ECGs for patients with chest pain.

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A Tough ECG, But Learn From It!

Dr. Smith's ECG Blog

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. On echocardiogram, there was a 40% ejection fraction with anterior wall motion abnormality. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain.

STEMI 52
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Precordial ST depression. What is the diagnosis?

Dr. Smith's ECG Blog

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.

STEMI 52
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A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

No chest pain. I think a good start would be a posterior EKG and a high quality contrast echocardiogram read by an expert. His inpatient clinicians did not think that an urgent angiogram was warranted given that he was chest pain free, his EKG appeared nondiagnostic, and serial troponins were not elevating beyond 2 ug/L.