Remove Chest Pain Remove Dysrhythmia Remove Risk Factors
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A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. There were no dysrhythmias on cardiac monitor during observation. See below for PM Cardio digitized version of this.

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An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

hours of substernal chest pressure. She had zero CAD risk factors. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. SCAD occurs in patients with few or non-traditional cardiovascular risk factors. Again, cath lab was not activated.

SCAD 52
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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.