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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. There is sinus tachycardia at ~100/minute. Vitals were normal.
Sinus tachycardia has many potential causes. This is especially true for the elderly patient with sinus tachycardia. What is the cause of the sudden tachycardia? The VSR is what is causing the cardiogenicshock! She had a very elevated troponin T at 12,335 ng/L at the time of presentation.
A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chestpain. There is sinus tachycardia. Symptoms other than chestpain (malaise, cough in a cancer patient) 2. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology.
This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chestpain. ACS and STEMI generally do not cause tachycardia unless there is cardiogenicshock. He had this ECG recorded. Are the lungs clear?
It shows sinus tachycardia with right bundle branch block. Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenicshock). As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenicshock.
I see the following: There is sinus tachycardia ( upright P wave with fixed PR interval in lead II ) — at the rapid rate of ~130/minute. Sinus Tachycardia and RAD — as already noted above. PEARL # 2: In the absence of associated heart failure ( cardiogenicshock ) — sinus tachycardia is not a common finding in acute MI.
This was my response: If it is the right clinical situation, such as acute chest discomfort, it looks like proximal left anterior descending occlusion with right bundle branch block and left anterior fascicular block. Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenicshock.
The findings include sinus tachycardia, characteristic QRS morphology most diagnostic in V3 with a small R wave followed by a very large S wave with a convex upward ST segment morphology, ST segment strain morphology in the inferior and anterior leads leading to deep symmetric T-wave inversion. The T-waves simply look different in Wellens'.
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chestpain, weakness and nausea. Authors' commentary: Cardiogenicshock in the setting of severe aortic stenosis. Fundamentally, cardiogenicshock is an issue of decreased cardiac output.
Tachycardia (or nearly) 2. And some similar ECGs from Pulmonary Embolism: A young woman with altered mental status and hypotension An elderly woman transferred to you for chestpain, shortness of breath, and positive troponin - does she need the cath lab now? Tachycardia, = 1.8. Poor R-wave progression 4.
But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chestpain was a little more intense, and the needed recovery period was longer in duration. Severe Tachycardia Acute Coronary Syndrome (obstructive coronary disease) a. This results in Type I MI.
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. An elderly man with sudden cardiogenicshock, diffuse ST depressions, and STE in aVR Literature 1.
He had concurrent sharp substernal chestpain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chestpain while running, but none at rest. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. Ken notes AV dissociation.
He woke up alert and with chestpain which he also had experienced intermittently over the previous few days. The history in today's case with sudden loss of consciousness followed by chestpain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think? This is an ominous sign.
They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chestpain. They described the chestpain as severe, crushing, and non-radiating. We can see enough to make out that the rhythm is sinus tachycardia. It was not worse with exertion or relieved by rest.
Here are more examples of wide complex tachycardia: these are all a mix of ventricular tachycardia and SVT with aberrancy. This 51 yo male complained of chestpain, then had a v fib arrest. He was in cardiogenicshock. There is tachycardia, and there is a wide complex.
There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) This pattern is essentially always accompanied by cardiogenicshock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenicshock but awake. Code STEMI was activated.
All of the patients presented with chestpain , and they are all in triage. The patient died of cardiogenicshock within 24 hours despite mechanical circulatory support. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician.
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.
His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chestpain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. This is her ECG: An obvious STEMI, but which artery?
When a person experiences a heart attack or myocardial infarction, they may feel chestpain and other symptoms in different parts of their body. The abnormal heart rhythms can further lead to death because of ventricular tachycardia and ventricular fibrillation. So, how do you recognize a heart attack?
A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chestpain and shortness of breath. She awoke in the morning with sharp chestpain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.
A middle-age woman with no previous cardiac history called 911 for chestpain. This was her prehospital ECG: What do you think? There is sinus rhythm with RBBB and obvious LAD OMI (proximal LAD occlusion): hyperacute T-waves in I, aVL and minimal STE in V1, V2. DOI: 10.1016/j.resuscitation.2025.110515
Written by Pendell Meyers An adult man presented with acute chestpain. It is a wide complex regular tachycardia at a rate of 120. Is it ventricular tachycardia? It is ofen downsloping This one is also a wide complex tachycardia. He appeared critically ill. Near 100% mortality without rapid reperfusion."
Sent by anonymous, written by Pendell Meyers A woman in her 40s with no known comorbidities presented with acute chestpain radiating to left arm and neck, which started approximately 4 hours prior to arrival. Vitals were reported as within normal limits except for tachycardia. 68 minutes with chest compressions, full recovery.
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