Bradycardia Chest Pain Pacemaker 
Dr. Smith's ECG Blog
AUGUST 9, 2024
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 chest pain and nausea. The patient continued having chest pain. These diagnoses were not found in his medical records nor even a baseline ECG.
Dr. Smith's ECG Blog
JUNE 19, 2024
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. His pain suddenly became much worse in the ED and he became acutely diaphoretic, dizzy, and hypotensive.
Dr. Smith's ECG Blog
MARCH 22, 2024
Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown: What do you think? That is, until the 7th R wave which comes a little bit sooner than expected. What do you think?
Ken Grauer, MD
JUNE 2, 2023
to 1828 msec. ) — which corresponds to a variation in the rate of sinus bradycardia from 36-to-33/minute. This makes sense given that the underlying rhythm in today's case appears to be marked sinus bradycardia and arrhythmia , with a ventricular escape rhythm appearing when the SA node rate drops below 33/minute.
Dr. Smith's ECG Blog
NOVEMBER 11, 2023
Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean.
Ken Grauer, MD
OCTOBER 13, 2023
She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. Is a pacemaker needed? Even if we stopped here — We could conclude the following: There is marked bradycardia in today's rhythm ( ie, Heart rate in the low 30s ). QUESTIONS: HOW would you interpret the rhythm in Figure-1 ?
Ken Grauer, MD
OCTOBER 27, 2023
That said — obvious findings include: i ) Marked bradycardia! — My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study. be regular! —
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