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Written by Jesse McLaren Two patients in their 70s presented to the ED with chestpain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Do either, both, or neither have occlusion MI? Vitals were normal.
There is no way to tell the difference between GI etiology of chestpain 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 chestpain are nearly diagnostic of ischemia. An emergency cardiacultrasound could be very useful.
This 80 year old with a history of CABG had a cardiacarrest. He did not state he had chestpain, but, then again, he couldn't remember anything. We did a bedside cardiacultrasound. The ECG and ultrasound could not have been differentiated from acute plaque rupture with occlusion of the RCA.
Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chestpain and shortness of breath at home in front of his family. He had multiple cardiacarrests with ROSC regained each time. Now another, with ultrasound. What is the Diagnosis?
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 chestpain without radiation or dyspnea. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?
Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chestpain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chestpain. Vitals were HR 58 BP 167/70 R20 sat 96%.
The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chestpain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.
No chestpain. His ED cardiacultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. Patients on dialysis often do not have chestpain in the setting of acute MI. Why is this? Herzog et al.
This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. On medic arrival, she walked out of the house in no distress, but was diaphoretic.
A late middle-aged man presented with one hour of chestpain. Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. If cardiacarrest from hypokalemia is imminent (i.e., Most recent echo showed EF of 60%. He had recently had a NonSTEMI. mEq/L, from 1.9
Case 3 : Male in 30's with chestpain, cough, and fever. A bedside ultrasound was done by the emergency physician, using Speckle Tracking. A male in late middle age with a history of RCA stent 8 years prior complained of chestpain. What do you think? He has clinical pneumonia. Called 911.
Case A 47 year old male called 911 for severe chestpain. He had a previous MI with cardiacarrest 2 years prior. A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chestpain with radiation to the anterior neck, with associated nausea.
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chestpain to Dr. McLaren. Thirty-six patients (36%) presented with cardiacarrest, and 78% (28/36) underwent emergent angiography.
Case Continued Bedside ultrasound was performed: This shows an anterior wall motion abnormality, and highly suggests the LAD as the infarct artery. FYI : 52 ng/L is the threshold for "rule in" by European studies as it has a high positive predictive value in the setting of chestpain.
Given her reported chestpain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? A bedside cardiacultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. Her pulse is 125.
A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chestpain, dyspnea and weakness on the treadmill. In the ED he had some continued chestpain and hypotension. In a report of 6 cases at our institution (Hennepin County Medical Center), 2 survived with cardiac surgery.
Patients who present with chestpain or cardiacarrest and have an ECG diagnostic of STEMI could have myocardial rupture. In a report of 6 cases at our institution (Hennepin County Medical Center), 2 survived with cardiac surgery. Obviously, administration of heparin and/or lytics is hazardous. Plummer D et al.
Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiacarrest in sleep. The patient denied any chestpain whatsoever, and a troponin at zero and 2 hours were both undetectable. We repeated the ECG: Brugada pattern is mostly resolved.
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