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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. This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. What do you think?
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 ). These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. This is OMI until proven otherwise.
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. PR depression, which suggests pericarditis 4. Here is that ECG: What do you think? There is sinus tachycardia.
Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chestpain. Several hours prior to presentation, while driving his truck, he started experiencing new central chestpain, without radiation, aggravating/alleviating factors, or other associated symptoms.
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chestpain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chestpain similar to his prior MI, but worse. The pain initially started the day prior to presentation. The ST elevation from today is ~0.2
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.
Upon questioning patient, he denies having any chestpain or chest tightness of any sort. Assessment:" " Nonspecific ST elevation from V1-V4 , question of early repolarization versus pericarditis , question of acute current of injury and ? Pericarditis would be even more unlikely in someone without chestpain.
Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." See this case: Persistent ChestPain, an Elevated Troponin, and a Normal ECG. A patient with OMI can have a totally normal ECG!"
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 %.
3 hours prior to calling 911 he developed typical chestpain. This rules out pericarditis, which essentially never has reciprocal ST depression. When flow is restored, wall motion may completely recover so that echocardiogram does not detect the previous ischemia. This is not pericarditis because: a.
There are other tests also for tuberculous pericarditis, but they not as sure as growing the bacterium in culture. Inflammation of pericardium as inflammation elsewhere can be painful and cause chestpain. But pericardial effusion can build up slowly without much pain.
A man in his 60's presented after 4 days of chestpain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP).
A man in his 60's presented after 4 days of chestpain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP).
Hopefully a repeat echocardiogram will be performed outpatient. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of ChestPain and Dyspnea Head On Motor Vehicle Collision. 1900: RBBB and LAFB are almost fully resolved.
They were recorded 12 minutes apart: "Hey Steve, 30-something with one week of chestpain, mostly right-sided, better with sitting up.": Get an emergent contrast echocardiogram. This history of a week of constant chestpain is also much more suggestive of myocarditis. What do you think? flat ST segment in V4 2.
Written by Willy Frick A 40 year old woman was at home cooking when she developed chestpain. The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex.
The pneumothorax was expanded with a chest tube At 17 hours, another ECG was recorded: It is now much less dramatic and has the morphology of Type 2 Brugada The hs troponin I peaked at 6500 ng/L -- this strongly suggests myocardial contusion. An echocardiogram was done. Is there also Brugada? Right ventricular prominence.
He was concerned because he had chestpain after his first mRNA vaccine and was uncomfortable with the risks of a second mRNA dose. He subsequently describes having sharp chestpain over the next few weeks. The pain resolved a few weeks later. He emphatically denies any history of cardiopulmonary disease.
Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP). Patients who present with chestpain or cardiac arrest and have an ECG diagnostic of STEMI could have myocardial rupture. 5 of 6 presented with chestpain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound.
This is a very bold statement in a type 1 diabetic with very concerning sounding chestpain. The patient was treated with aspirin and a GI cocktail, which did not help the pain. Echocardiogram was finally performed five hours after the first diagnostic ECG. Echocardiogram showed LVEF 33% with akinesis of the lateral wall.
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