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Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chestpain radiating to his back. Due to the chestpain radiating into the patient's back, the ER physician ordered CTA chest to rule out aortic dissection. He had associated nausea, vomiting, and dyspnea.
Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chestpain. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It started while he was at rest after finishing a workout.
Clinical introduction A man in his 40s with a history of hyperlipidaemia presented with intermittent, dull left-sided chestpain for 2 weeks that was not consistently exertional. Physical examination, an ECG, basic laboratories and a chest X-ray were unremarkable. A transthoracic echocardiogram was performed ( figure 1 ).
Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( ChestPain ). Elevated troponins prompted an echocardiogram — which revealed an apical wall motion abnormality (WMA). Patient #1 in today's post did not get expert ECG interpretation.
Echocardiogram showed LVEF 66% with normal wall motion and normal diastolic function. He did not remember whether he had experienced any chestpain. Two subsequent troponins were down trending. Within a few days, the patient was extubated and was neurologically intact.
A 60-something yo female presented w/ exertional chestpain for 3 days. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. But the patient has active chestpain.
A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chestpain. Symptoms other than chestpain (malaise, cough in a cancer patient) 2. Inclusion criteria were chestpain, at least 2 serial cTnI in 24 hours, sinus rhythm , and at least 1 ECG.
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. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chestpain.
[link] A 30 year-old woman was brought to the ED with chestpain. She had given birth a week ago, and she had similar chestpain during her labor. She attributed the chestpain to anxiety and stress, saying "I'm just an anxious person." The initial troponin I was elevated at 0.75
He complained of severe chestpain and was extremely agitated, so much so that he was throwing chairs in triage. Some time later, reperfusion T-waves developed (analogous to Wellens' waves): Case 3 Here is a case of a 30-something otherwise healthy male with chestpain: There is neither an S-wave nor J-wave in lead V3.
Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chestpain. The chestpain started about one hour prior to arrival while bike riding.
Upon questioning patient, he denies having any chestpain or chest tightness of any sort. In the absence of chestpain and negative troponin , it appears less likely that he is having acute coronary syndrome though EKG appears concerning. Pericarditis would be even more unlikely in someone without chestpain.
A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chestpain. EMS gave 324 mg aspirin and 3 sublingual NTG, which the patient stated reduced the substernal chestpain from an 8/10 to 4/10. Pain better still. What do you think the echocardiogram shows? NTG drip started.
While in the ED, patient developed acute dyspnea while at rest, initially not associated with chestpain. He later developed mild continuous chestpain, that he describes as the sensation of someone standing on his chest. See this post: What do you think the echocardiogram shows in this case?
The patient’s chestpain spontaneously resolved before he was evaluated and has a repeat ECG obtained at 22:12 obtained shown below. In context, of course, it is clear that the patient is reperfusing, as pain has dissipated and the diagnostic findings of OMI have become more nonspecific. This ECG is more difficult.
The medics stated he had been nauseated and diaphoretic, but he did not have any chestpain or SOB. And especially suspect Old MI when the patient gives a history of MI and has no chestpain or SOB. Case continued The patient underwent an emergency formal echocardiogram and it was unchanged. Learning Points: 1.
Submitted by Benjamin Garbus, MD with edits by Bracey, Meyers, and Smith A man in his early 30s presented to the ED with chestpain described as an “explosion" of left chest pressure. Today’s pain lasted around 20 mins, but was severe enough that the patient called EMS. Triage EKG: What do you think? Do NOT use them.
After 24 hours, the patient was readmitted to the hospital with chestpain and troponin elevation, without ECG changes. A transthoracic echocardiogram (TTE) revealed a mobile mass on the right coronary cusp of the aortic valve ( figure 1 , ). The patient was discharged and apixaban was restarted 10 hours later.
Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chestpain that started while exercising. Formal echocardiogram: Systolic function is at the lower limits of normal. Three patients with chestpain and “normal” ECGs: which had OMI? Which were normal?
Our report describes two cases of SVS treated with endocardial ablation to improve LVOTO.Case reportCase 1: A 74-year-old female patient with angina and syncope was admitted to the hospital and diagnosed with SVS by transthoracic echocardiogram. After RFA was performed, the patient's symptoms significantly improved.
He reports significant chestpain at the base of his scapula on the right side along with new shortness of breath. First troponin I returns at 48 ng/L ECG 5 143 min No significant change ECG 6 261 min Same hs Troponin I profile (peaked at 1849): Formal Echocardiogram SUMMARY The estimated left ventricular ejection fraction is 74 %.
He arrived to the ED by helicopter at 1507, about three hours after the start of his chestpain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chestpain around 1500 while eating. The prehospital ECG of Patient #1 — showed an obvious acute STEMI.
On the second morning of his admission, he developed 10/10 chestpain and some diaphoresis after breakfast. The patient was given opiates which improved his chestpain to 7/10. The consulting cardiologist wrote in their note: “Could be cardiac chestpain. She is usually incredibly good at recognizing them!
He was admitted to our hospital with issues of chestpain, shortness of breath and heart palpitations without any obvious inducement. Figure 1 Transthoracic echocardiogram. (A) A 12-lead ECG indicated sinus rhythm with a heart rate of 78 bpm. A) Parasternal long-axis view of the.
Twenty-one (41%) had normal echocardiogram, 13 (25%) a hypokinetic non-dilated cardiomyopathy (HNDC) and 17 (33%) a dilated cardiomyopathy (DCM). Clinical contexts leading to diagnosis were SCD in 3 (6%), ventricular arrhythmias in 15 (29%), chestpain in 8 (15%), heart failure in 6 (12%) and familial screening in 20 (38%).
An echocardiogram showed newly reduced left ventricular ejection fraction of 30-35%. He had minimal in-stent restenosis on angiography but had only minimal cardiac enzyme elevation and did not have antecedent chestpain before either of his events.
The echocardiogram showed normal cardiac structure and function, however, there was a concern for possible anomalous origin of the left coronary artery. Treadmill exercise stress test showed excellent functional capacity without exercise-induced chestpain or ischemic ECG changes.
Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chestpain for 2 months. EKG, cardiac enzymes, and Initial echocardiogram(TTE) was unremarkable.
This ECG could easily be seen in an ED chestpain patient, and I have seen many) What do you think? Comment I (Smith) have seen many similar ECGs in ED chestpain patients. I have seen this innumerable times in chestpain patients in the Emergency Department. Description Sinus bradycardia.
He reported typical chestpain since 4H AM and arrived at our ED at 10h with ongoing chestpain. The echocardiogram shows a preserved left ventricular ejection fraction (LVEF) of 55% with marked basal and mid inferolateral and basal anterolateral hypokinesia. The first ECG (10h14) showed TWI in inferior leads."
This male in his 40's had been having intermittent chestpain for one week. He awoke from sleep with crushing central chestpain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric. The peak troponin I was 0.364 ng/ml.
A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chestpain. He had no h/o heart failure. Regional wall motion abnormality-inferior. Regional wall motion abnormality-inferolateral. This means posterior in common terminology) --Normal LV cavity size with moderately increased thickness.
He denied chestpain. In this study of consecutive patients with LBBB who were hospitalized and had an echocardiogram, a QRS duration less than 170 ms (n = 262), vs. greater than 170 ms (n = 38), was associated with a significantly better ejection fraction (36% vs. 24%). So indeed the QRS is approximately 200 ms.
Case presentation:A 64-year-old man presented with one day of chestpain. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 40% and a moderate-large pericardial effusion with signs of tamponade. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024.
He had no chestpain. The computer read is: **Acute MI ** The protocol for prehospital activation in the EMS system that this patient presented to requires 2 elements: 1) Chestpain 2) A computer read of **Acute MI ** Only 1 of 2 was present, so there was no prehospital activation. The patient was transported to the ED.
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. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded. Troponins peaked at 0.275 ng/ml.
Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chestpain: V5 and V6 sure look like a STEMI For this ECG and chestpain in the ED, the Cath lab activated. But the angiogram was clean.
This middle aged male with h/o GERD but also h/o stents presented to the ED with chestpain. The initial troponin I returned at 1500 ng/L and another ECG was recorded as the patient complained of 9/10 chestpain at 10 hours after the first Now the T-wave in III is fully upright, suggesting re-occlusion.
No patient with chestpain should be sent home without troponin testing. An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. An echocardiogram showed an EF of 20-25%. Three months later, he had a follow up appointment for a reassessment of his LV function.
Yes, COVID-19 symptoms can resemble a heart attack, including chestpain, shortness of breath, and changes in echocardiogram or EKG. Myocarditis symptoms can also mimic a heart attack, and small blood clots may cause pain. Can COVID-19 symptoms mimic a heart attack?
Pain is similar, but associated with less SOB. A stat echocardiogram would have helped to make this diagnosis and facilitate timely reperfusion. Possibilities include: serial ECGs (which were done but still nondiagnostic), stat echocardiogram, or posterior ECG. The pain is very nitroglycerine responsive.
However, an echocardiogram is a different test, also conducted for heart activity. If you experience any symptoms, such as chestpain, dizziness, unusual tiredness or fatigue, shortness of breath, or irregular heartbeat, your doctor would want you to go for an ECG test to find out the underlying cause.
Written by Pendell Meyers A man in his 60s presented with acute chestpain. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH. Leads V5-6 are suspicious for upright, enlarged T waves that are possibly inappropriate for the QRS complex, especially V6.
This was my thought: if this patient presented to the ED with chestpain, then this is an LAD occlusion. On echocardiogram, there was a 40% ejection fraction with anterior wall motion abnormality. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chestpain.
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