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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. Past medical history included diabetes and hypertension.
This one is far more specific, as it is combined with sinus tachycardia and some T-wave inversion in V1-V3. and tachycardia, 1.8. Finally , they found that S1Q3T3, precordial T-wave inversions V1-V4, and tachycardia were independent predictors of PE. This is a classic S1Q3T3. Most S1Q3T3 is not due to PE. incomplete RBBB 1.7
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? She had a very elevated troponin T at 12,335 ng/L at the time of presentation. The patient in today’s case suddenly became tachycardic while sleeping.
Pulse was 115, BP 140/65, and afebrile He was found to have cellulitis and to be in diabetic ketoacidosis, with bicarb of 14, pH of 2.27, glucose of 381, anion gap of 18, and lactate of 2.2 While in the ED, patient developed acute dyspnea while at rest, initially not associated with chestpain. There is widespread ST depression.
A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. On the second morning of his admission, he developed 10/10 chestpain and some diaphoresis after breakfast.
His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. There is some ST-segment elevation in DII, DIII, aVF, V4-6. What is the rhythm?
There is sinus tachycardia. The above is what I thought when I saw this, so I went to the chart and found this history: A type I diabetic aged approximately 35 years old presented with chestpain, nausea, vomiting and diffuse abdominal pain. I saw this as I was reading a large a stack of ECGs: What do you think?
Case 2: sent by Dr. James Alva A man in his 50s with diabetes, hypertension, and hyperlipidemia presented to the ED with chestpain and shortness of breath off and on over the past three days, with associated vomiting. The rhythm is sinus tachycardia at ~105/minute. The rhythm is sinus tachycardia at ~115/minute.
Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. A normal PR interval.
Palpitations in a Young Healthy Male A pathognomonic ECG you should recognize instantly A middle-aged man with severe syncope, diffuse weakness Chestpain and Diffuse ST depression, with STE in aVR. Biphasic T-waves in a Middle-Aged Male with Vomiting Diabetic Ketoacidosis: is there hypokalemia? Are These Wellens' Waves??
This results in severe chestpain or discomfort, with the subsequent release of cardiac biomarkers, and alterations in the electrocardiogram. Hypertension and diabetes were the two most common risk factors identified. It can cause diminished heart function and mortality if not treated properly with suitable measures.
POTS stands for postural orthostatic tachycardia syndrome. Let’s call it Postural Orthostatic Tachycardia Syndrome – that’s not really a diagnosis – it’s just a medical jargon filled term for what the patient has just told us. What is POTS? When you examine them, the heart rate can be found to be excessively fast.
I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information: A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed. MY Thoughts on ECG #1: The rhythm is sinus tachycardia at 105-110/minute.
A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chestpain. They denied fever, cough, dyspnea, and sick contacts.
Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. He woke up alert and with chestpain which he also had experienced intermittently over the previous few days. The syncope lasted about 2-3 minutes according to his wife.
However, recent studies have observed that people below 40 are also experiencing heart attacks due to high blood pressure, cholesterol, diabetes, smoking, obesity, a sedentary lifestyle, and social and mental stress. The abnormal heart rhythms can further lead to death because of ventricular tachycardia and ventricular fibrillation.
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