Remove Cardiac Arrest Remove Chest Pain Remove Pericarditis
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A woman in her 70s with chest pain

Dr. Smith's ECG Blog

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She felt nauseous and lightheaded with no neurologic deficits.

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Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

All of the patients presented with chest pain , and they are all in triage. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI? What was the pH and K?

Ischemia 112
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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. He had multiple cardiac arrests with ROSC regained each time. Submitted by a Med Student, with Great Commentary on Bias!

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Inferior ST Elevation: what is the Diagnosis?

Dr. Smith's ECG Blog

T-wave to ST ratio is greater than 4 in lead V6, making pericarditis unlikely (also there were no symptoms of pericarditis). It turns out that this was a 27 yo African American male who presented with pressure-like (non-pleuritic) chest pain and dyspnea. Sudden cardiac arrest associated with early repolarization.

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A woman in her 20s with syncope

Dr. Smith's ECG Blog

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. She was noted to be tachycardic and her heart sounds were distant on physical exam.

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Cardiologist declines taking patient to the cath lab. Patient dies.

Dr. Smith's ECG Blog

Apparently he denied chest pain. As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain.

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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. ST depression. Myocardial Contusion?