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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?
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.
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.
The rhythm is uncertain ( ie, We only see 4 beats — because the same 4 beats are repeated in limb and chest leads — but in lead II there appears to be sinus bradycardia and arrhythmia plus a P wave with a PR interval too short to conduct preceding beat #1 — therefore need for a longer period of monitoring ).
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.
As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. Like other cases on this blog who died before cath was done, I cannot prove that this patient had OMI. I do not accept the transfer." "It Were they right?
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.
Pericarditis? A straight ST segment virtually never happens in inferior ST elevation that is NOT due to OMI (normal variant, pericarditis) 4. This is sinus bradycardia. 60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. Time zero What do you think? Is it normal variant?
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.
Patient 2 : 55 year old with 5 hours of chest pain radiating to the shoulder, with nausea and shortness of breath ECG: sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. Smith : The fact that the ECG did not evolve is further proof that this was the baseline ECG. nearly identical to the first case).
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.
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 ).
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