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Written by Jesse McLaren Four patients presented with chestpain. 4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6] Hughes KE , Lewis SM , Katz L , Jones J. Acad Emerg Med.
Written by Jesse McLaren A previously healthy 50 year-old presented with 24 hours of intermittent exertional chestpain, radiating to the arms and associated with shortness of breath. In a previously healthy patient with new and ongoing chestpain, this is concerning for acute occlusion of the first diagonal artery.
It is from a 50-something with chestpain: What do you think? Up until recently — all computerized ECG interpretation programs that I am aware of used standard millimeter-based STEMI critieria as the basis for determining which chestpain patients should "qualify" for prompt cath with PCI. This was sent to me by a friend.
Introduction:Over 6 million patients (pts) present to US emergency departments annually with chestpain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. Length of stay (LOS) in the CPU to discharge was 10.4
Cardiovascular consultation had been requested for all of the patients based on their primary clinical examination, vital signs, and electrocardiogram (ECG). Manifestations of CVDs, such as chestpain, abnormal serum markers, unstable angina, myocardial infarction (MI), myocarditis, and new-onset hypertension, were documented.
He denied chestpain or shortness of breath. In the clinical context of weakness and fever, without chestpain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon.
This was just published in JAMA Internal Medicine: The de Winter Electrocardiogram Pattern Evolving From Hyperacute T Waves It reminded me that many believe, due to the assertions in the original de Winter's article, that de Winter's waves are stable. He was a 30-something with chestpain. Here is one case of a patient I saw.
This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chestpain, lasting 5 minutes at a time, with several episodes over the past couple of months. Plan was for admission for chestpain workup. Patel DJ, et al.
Meyers, Weingart and Smith published their OMI Manifesto — in which they extensively document the critically important concept that management of acute MI by separation into a “STEMI” vs “non-STEMI” classification is an irreversibly flawed approach. ST depression that is maximal in leads V2-to-V4.
The diagnosis was made based on classic findings of inflammation on an electrocardiogram associated with acute chestpain. 2-3 days after this he developed the same sharp chestpain and shortness of breath with elevated inflammatory markers (CRP) as well as typical findings of pericarditis seen on ECG.
This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chestpain. See below how this has been documented. A deep neural network for 12-lead electrocardiogram interpretation outperforms a conventional algorithm, and its physician over-read, in the diagnosis of atrial fibrillation. Poon et al.
It was from a patient with chestpain: Note the obvious Brugada pattern. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. There is no further workup at this time.
Check : [vitals, SOB, ChestPain, Ultrasound] If the patient has Abdominal Pain, ChestPain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.
Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. The patient denied any chestpain whatsoever, and a troponin at zero and 2 hours were both undetectable. Bayes de Luna, A et al. Is this Type 2 Brugada syndrome/ECG pattern?
She did not even need to ask in this case, because even if the patient presented with chestpain, she would call it NEGATIVE. The emergency physician does cautiously (correctly) note that the ECG meets STEMI criteria in V3 and V4, but goes on to document absence of ACS symptoms.
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