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Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chestpain. LAFB, atrialflutter, anterolateral STEMI(+) OMI. Sent by Pete McKenna M.D. Triage ECG: What do you think?
She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. She presented to the emergency department after a couple of days of chest discomfort. The ECG below was recorded. This is very prolonged.
This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chestpain. MAT has at least 3 distinct P-wave morphologies, but there is no single dominant pacemaker (i.e., no underlying sinus rhythm) Rhythm Diagnosis: Sinus Rhythm with Multifocal Premature Atrial Beats (PACs or PABs), many conducting aberrantly.
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. Syncope with Exertion (EGSYS) 7.
Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chestpain. He said he had had three episodes of chestpain that day while urinating. How does a pacemaker accomplish RBBB morphology? ECG 1 What do you think?
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