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A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chestpain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. At times the pain does go to his left neck. It is a ssociated with mild dyspnea on exertion. Am Heart J.
He had suffered a couple bouts of typical chestpain in the last 24 hours. This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. The pain had lasted about one hour. Case A 40-something male presented to triage. There are classic Wellens' waves in V2-V5. Am Heart J.
A 70-year-old man calls 911 after experiencing sudden, severe chestpain. New electrocardiographic criteria for posterior wall myocardial ischemia validated by percutaneous transluminal coronary angioplasty model of acute myocardial infarction. This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! Neth Heart J.
There is a patient with persistent chestpain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chestpain patient. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Is there STEMI?
He reports significant chestpain at the base of his scapula on the right side along with new shortness of breath. Wellen's waves indicate that, when the patient was having chestpain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o.
This male in his 40's had been having intermittent chestpain for one week. He awoke from sleep with crushing central chestpain 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. Wehrens X.H., Doevendans P.A., Ophuis T.J.,
This was my thought: if this patient presented to the ED with chestpain, then this is an LAD occlusion. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chestpain. Ann Emerg Med 1998;31(1):3-11. Wang T, Zhang M, Fu Y, et al. Marti D et al.
No chestpain. Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chestpain. ( The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. What is the rhythm ?
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