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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.
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.
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.
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.
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.
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.
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.
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. The corrected QT interval is extremely long, about 500 ms.
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