Remove Bradycardia Remove Hypertension Remove Ischemia
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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Dr. Smith's ECG Blog

A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. No ischemia. Case continued Another ECG was recorded 3 hours later, still 1/10 pain: There is sinus bradycardia with RBBB. A rising troponin does NOT mean that there is active ischemia.

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Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder. The ECG does not show any definite signs of ischemia. Written by Magnus Nossen The patient in todays case is a 50 year old male. He denied any exertional chest pain. The below ECG was recorded.

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A 50-something with chest pain. Is there OMI? And what is the rhythm?

Dr. Smith's ECG Blog

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. The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible.

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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Q waves in association with RBBB are usually not seen in anterior leads unless there is pulmonary hypertension or anterior infarction. Chest trauma was suspected on initial exam.

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Diffuse ST depression, and ST elevation in aVR. Left main, right?

Dr. Smith's ECG Blog

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Ischemia b. ST depression: is it ischemia? Does this patient have hypertension and/or heart failure that has worsened? It was a baseline finding in 62% of patients, usually due to LVH.

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See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness.

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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

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.