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Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chestpain, hypotension, dyspnea, and hypoxemia. The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) The rhythm is 2:1 atrialflutter.
In the evening, a middle-aged man complained of chestpain at the nursing home. His chestpain was vague. He mentioned "cancer" and "chest". Leads II and aVF appear to have flutter waves. I diagnosed atrialflutter with 2:1 conduction. He was awake, with a pulse of 130 and BP of 50/30.
A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chestpain, sharp, radiating down left arm, cramping, that waxes and wanes but never goes completely away. A chest X-ray was obtained: This was read by radiology as "Bilateral lower lobe interstitial opacities.
This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chestpain. M Y A NSWER: In my experience, MAT is the 2nd-most commonly overlooked cardiac arrhythmia ( surpassed only by AtrialFlutter ). The patient in this case presented with dyspnea and chestpain. GET a 12-lead!
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.
Possible but, again, the QRS morphology is atypical 3) AtrialFlutter with 2:1 conduction and "aberrancy". I do not see flutter wave baseline, and again the QRS morphology is not typical for a supraventricular rhythm. With OMI, all you know is that your patient has some nonspecific chestpain, SOB, shoulder pain etc.
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