Remove Cardiac Arrest Remove Chest Pain Remove Ischemia
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A man in his 50s with acute chest pain who is lucky to still be alive.

Dr. Smith's ECG Blog

Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. The primary care physician there evaluated this patient and deemed the chest pain to be due to gastrointestinal causes. In this case, the EMS provider was routed to the urgent care facility.

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Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Dr. Smith's ECG Blog

The ECG shows severe ischemia, possibly posterior OMI. But cardiac arrest is a period of near zero flow in the coronary arteries and causes SEVERE ischemia. It takes time for that ischemia to resolve. After cardiac arrest, I ALWAYS wait 15 minutes after an ECG like this and record another.

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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

This was interpreted by the treating clinicians as not showing any evidence of ischemia. However, he did not remember much from the day of the arrest. He did not remember whether he had experienced any chest pain. He was intubated in the field and sedated upon arrival at the hospital. He was admitted to cardiology.

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Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Smith comment: The patient was lucky to have a cardiac arrest. By undergoing an arrest, providers became aware of his OMI which had not been noticed on his diagnostic ECG, and he thus has a chance at some myocardial salvage.

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A 50-something man with Chest pain at triage

Dr. Smith's ECG Blog

A 50-something male presented to triage with chest pain for one day. A Chest X-ray showed infiltrates. Thus, another etiology of chest pain is found, and the fever suggests "fever-induced Brugada." Unexplained cardiac arrest or documented VF/polymorphic VT: +3 3. Ischemia or infarction.

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Missed myocardial infarction with subsequent cardiac arrest

Dr. Smith's ECG Blog

There is no way to tell the difference between GI etiology of chest pain and MI. Such T-waves are almost always reciprocal to ischemia in the region of aVL (although aVL looks n ormal here) , and in a patient with chest pain are nearly diagnostic of ischemia. Could this have been avoided? Lesson : 1.

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Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time. The ECG does not show any definite signs of ischemia. The below ECG was recorded.