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Written by Bobby Nicholson MD and Pendell Meyers A man in his 30s presented to the ED for evaluation of chestpain and palpitations. The differential of wide complex irregularly irregular includes: polymorphic VT, atrialfibrillation with WPW, atrialfibrillation with other aberrancy.
An elderly dialysis patient presented with chestpain. Regular means it can't be atrialfibrillation --Most regular wide complex tachcardia are VT, especially if the patient has poor LV function, as in this case. She has poor LV function. Severely decreased LV function. Here is her ECG: Regular Wide Complex Tachycardia.
This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chestpain. It is not atrialfibrillation. The rhythm is indeed irregularly irregular, so atrialfibrillation must be considered. Multifocal Atrial Tachycardia 2. Here is the ECG: What do you think? Sinus with multifocal PACs 3.
In that sense, the term dysrhythmia is preferable because it does literally translate as a disturbance in normal rhythm which is exactly what it is meant to describe. Any unsolicited disturbance of the rate or rhythm can be termed a dysrhythmia and result in the heart beating less efficiently but only for the duration of the dysrhythmia.
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?
Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chestpain and shortness of breath at home in front of his family. The rhythm is atrialfibrillation. Chestpain, SOB, Precordial T-wave inversions, and positive troponin.
She reports that she is now unable to vagal out of her palpitations and is having shortness of breath and dull chestpain. The differential of a regular narrow QRS tachycardia is sinus tachycardia, SVT, and atrial flutter with regular conduction. This includes sinus tachycardia, atrialfibrillation or flutter, MAT, and others.
A late middle-aged man presented with one hour of chestpain. There is atrialfibrillation. Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). Most recent echo showed EF of 60%.
Inferior MI results in scar tissue which is a likely source of a re-entrant ventricular dysrhythmia. Knowing the rhythm is precisely regular rules out any possibility of atrialfibrillation — and facilitates calculation of heart rate. This would be the likely source of the VT.
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chestpain, weakness and nausea. This was contributed by some folks at Wake Forest: Jason Stopyra, Shannon Mumma, Sean O'Rourke, and Brian Hiestand.
Check : [vitals, SOB, ChestPain, Ultrasound] If the patient has Abdominal Pain, ChestPain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.
This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chestpain and SOB, worsening over days, with orthopnea. BP:143/99, Pulse 109, Temp 37.2 °C C (99 °F), Resp (!) 32, SpO2 95% On exam, he was tachypneic and had bibasilar crackles.
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