This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
A 56 year old male with PMHx significant for hypertension had chestpain for several hours, then presented to the ED in the middle of the night. He reported chestpain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike.
Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chestpain and nausea. The patient continued having chestpain. These diagnoses were not found in his medical records nor even a baseline ECG.
No ChestPain, but somnolent. The fact that this is syncope makes give it a far lower pretest probability than chestpain, but it was really more than syncope, as the patient actually underwent CPR and had hypotension on arrival of EMS. Here is the ED ECG (a photo of the paper printout) What do you think?
A 50-something man presented in shock with severe chestpain. Here is his ED ECG: There is bradycardia with a junctional escape. Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. His prehospital ECG was diagnostic of inferior posterior OMI. He appeared gray in color, with cool skin.
Written by Jesse McLaren, with edits from Smith and Grauer A 60 year old with no past medical history presented with two hours of chestpain radiating to the left arm, with normal vitals. Pseudo ventricular hypertrophy and pseudo myocardialinfarction in Wolff-Parkinson-White syndrome. What do you think? Khan and Shaw.
The patient presented with chestpain. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chestpain for the ischemia and potential syncope for brugada. Only 5-18% of ED patients with chestpain have a myocardialinfarction of any kind.
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chestpain for 3 hours prior to arrival. At this time he reported ongoing chestpain and was given aspirin and nitroglycerin. J Am Heart Assoc.
This ECG could easily be seen in an ED chestpain patient, and I have seen many) What do you think? Description Sinus bradycardia. Comment I (Smith) have seen many similar ECGs in ED chestpain patients. I have seen this innumerable times in chestpain patients in the Emergency Department.
The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chestpain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Some residual ischemia in the infarct border might still be present.
A 55 year old with no previous cardiac history presented with 3 hours of chestpain. The pain was persistent and reportedly still present at the time of the ECG. Translation from French: Acute Occlusion MyocardialInfarction with High Confidence. He has now implemented the Queen of Hearts in his hospital.
The relationship between low RHR and CI has yet to be described.Purpose:We hypothesize that resting sinus bradycardia (low RHR) could be a predictor of chronotropic incompetence and reduced exercise capacity.Methods:The derivation cohort consists of 201 patients with normal Bruce protocol treadmill stress echocardiogram. x age in years).Results:The
A 40-something male with no previous cardiac disease presented with chestpain. The pain continued and the first high sensitivity troponin I returned at 105 ng/L Another ECG was recorded: The ST segment in aVF has flattened a bit, revealing that there is some STD in addition to the non-specific findings in III and aVL.
A late middle-aged man presented with one hour of chestpain. There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. 1987;147(3):465-469.
This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chestpain. Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. What do you think? Ischemic ST depression maximal in V1-V4 (vs.
Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation MyocardialInfarction. This is the initial ED ECG of a 46 year old male with chestpain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 Annals of Emergency Medicine 2012;60:45-56. QRS V2 = 15.5
Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The ECG shows sinus bradycardia but is otherwise normal. So there is probability of myocardial injury here (and because it is in the correct clinical setting, then myocardialinfarction.)
Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardialinfarction. International Journal of Cardiology Heart & Vasculature Case A 40-year-old man presents with excruciating back pain which has started 1 hour ago. References 1. 2021.21026.
Here are inferior leads, and aVL, magnified: A closer inspection of the inferior leads and aVL Sinus bradycardia. She went on to describe her chestpain as a "buffalo sitting on my chest" and a "weird" sensation in her jaw for 1 hour prior to arrival, associated with lightheadedness and diaphoresis. What do you think?
Detailed Considerations LBBB and MyocardialInfarction In the emergent setting it’s important to assess LBBB through the lens of the Smith-modified Sgarbossa criteria, especially in a context that is clinically consistent with Acute Coronary Syndrome. He received a permanent pacemaker during the subsequent inpatient stay. 4] Dodd, K.
Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chestpain. There’s sinus bradycardia, normal conduction, normal axis, delayed R wave progression, and normal voltages. Inferior infarct, age undetermined. Sinus bradycardia.” HR 40, BP 135/70, RR16, O2 100%. Kontos et al.
Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chestpain that feels like heartburn but that radiates to the left arm. There’s sinus bradycardia, first degree AV block, normal axis, delayed R wave progression, and normal voltages. Below is the ECG. Take home 1.
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. Frequent or repetitive PACs ii.
Despite the baseline artifact theres sinus bradycardia, convex ST elevation in III, reciprocal ST depression in aVL and possible anterior ST depression indicating inferoposterior OMI. Prevalence and outcome of patients with non-ST segment elevation myocardialinfarction with occluded culprit artery - a systemic review and meta-analysis.
Within ten minutes, she developed bradycardia, hypotension, and ST changes on monitor. If this were OMI, I would favor proximal RCA culprit (since that commonly produces inferolateral changes and occasionally produces anterior HATW from RV infarct ), but LAD is also possible. Bradycardia and heart block are very common in RCA OMI.
We organize all of the trending information in your field so you don't have to. Join thousands of users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
Let's personalize your content