Remove Bradycardia Remove Chest Pain Remove Pericarditis
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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. His pain suddenly became much worse in the ED and he became acutely diaphoretic, dizzy, and hypotensive.

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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. RBBB in blunt chest trauma seems to be indicative of several RV injury. ST depression. Myocardial Contusion?

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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.

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Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

Dr. Smith's ECG Blog

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. 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. Time zero What do you think?

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Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

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. Other Arrhythmias ( PACs, PVCs, AFib, Bradycardia and AV conduction disorders — potentially lethal VT/VFib ).