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What would you do with acute chest pain and this ECG? You might see what the Queen thinks.

Dr. Smith's ECG Blog

Three months prior to this presentation, he received a pacemaker for severe bradycardia and syncope due to sinus node dysfunction. The undergraduate continues: This new EKG pattern is more suggestive of acute pericarditis. Usually with pericarditis, some degree of PR segment depression is expected. This EKG seems to lack it.

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OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.

Dr. Smith's ECG Blog

A repeat ECG was performed as adult cardiology was asked to evaluate the patient for emerget PCI: Sinus bradycardia with persistent elevation in the inferior leads with reciprocal depression in aVL Patient was taken to cath lab with adult cardiology which revealed normal coronary arteries without evidence of occlusion MI.

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Vomiting, Diarrhea, and "Bubbles in my Chest"

Dr. Smith's ECG Blog

This ECG was recorded on arrival in the ED: Here is the interpretation of the conventional algorithm (Veritas): SINUS BRADYCARDIA ST ELEVATION, PROBABLY EARLY REPOLARIZATION [ST ELEVATION WITH NORMALLY INFLECTED T-WAVE] BORDERLINE ECG What do you think? Further management Underwent emergent 4 vessel CABG.

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31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

Dr. Smith's ECG Blog

Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?

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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. I've copied KEY points from My Comment in the August 6, 2022 post in Dr. Smith's ECG Blog — regarding the answer to this question.

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Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. This is the 2nd ECG from the February 8, 2022 post in Dr. Smith's ECG Blog ).

STEMI 52
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Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??

Dr. Smith's ECG Blog

Here is his previous ECG: This was my interpretation of the first ECG: Sinus bradycardia with less than 1mm ST elevation in V4-V6, elevated compared to the previous ECG, suggestive of lateral MI. In patients with suspicion of acute MI who have any ST elevation, aVL is also a very useful lead to differentiate between pericarditis and MI.