Remove Atrial Flutter Remove Chest Pain Remove Pulmonary
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What does the ECG show in this patient with chest pain, hypotension, dyspnea, and hypoxemia?

Dr. Smith's ECG Blog

Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chest pain, 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 atrial flutter.

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A Middle-Aged Man with Chest pain, Hypotension and Tachycardia

Dr. Smith's ECG Blog

In the evening, a middle-aged man complained of chest pain at the nursing home. His chest pain was vague. He mentioned "cancer" and "chest". Leads II and aVF appear to have flutter waves. I diagnosed atrial flutter with 2:1 conduction. He was awake, with a pulse of 130 and BP of 50/30.

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Ischemic ST depression maximal in V1-V4 (vs. V5-V6), even if less than 0.1 millivolt, is specific for Occlusion Myocardial Infarction (vs. subendocardial non-occlusive ischemia)

Dr. Smith's ECG Blog

A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chest pain, 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.

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Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. M Y A NSWER: In my experience, MAT is the 2nd-most commonly overlooked cardiac arrhythmia ( surpassed only by Atrial Flutter ). The patient in this case presented with dyspnea and chest pain. GET a 12-lead!

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.

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What is this rhythm? And why rhythm problems are easier for the Emergency Physician than acute coronary occlusion (OMI).

Dr. Smith's ECG Blog

Possible but, again, the QRS morphology is atypical 3) Atrial Flutter 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 chest pain, SOB, shoulder pain etc.