Remove Bradycardia Remove Chest Pain Remove Coronary Angiogram
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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

Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. He described his chest pain as pleuritic and reported that it started the day prior while swinging a golf club. The ED provider ordered a coronary CT scan to assess the patient for CAD. In lead I, about 1.5

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A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

The patient’s chest pain spontaneously resolved before he was evaluated and has a repeat ECG obtained at 22:12 obtained shown below. Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. It is unclear if he received aspirin at triage. This ECG is more difficult.

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Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder.

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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. Here is the coronary angiogram: A distal thrombotic right coronary artery (RCA) occlusion ! Blood pressure: 130/80 mmHg, heart rate: 45/min, respiratory rate: 18/min, SaO2: %98, body temperature: normal. No reciprocal ST-segment depression (STD). --QT

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