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IntroductionAcute coronary syndrome refers to a group of diseases characterized by sudden, decreased blood supply to the heart muscle that results in cell death, also known as acute myocardialinfarction. The majority of patients (67.9%) have been diagnosed with ST- Elevated MyocardialInfarction and were classified as Killip class I.
2 middle aged males presented with chestpain. Which had the more severe chestpain at the time of the ECG? Patient 2 at the bottom with a very subtle OMI complained of 10/10 chestpain at the time the ECG was recorded. 414 patients were included in the analysis.
Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chestpain. Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chestpain as a “STEMI equivalent”[3] 3. ST depression in lead AVL differentiates inferior ST-elevation myocardialinfarction from pericarditis.
Written by Pendell Meyers A man in his early 40s experienced acute onset chestpain. The chestpain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset. Am J Emerg Med. 2022 Jan;51:384-387.
A 50-something man presented in shock with severe chestpain. Literature cited In inferior myocardialinfarction, neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction Johanna E. The patient was in clinical shock with a lactate of 8.
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.
Written by Pendell Meyers A middle aged man called EMS for acute chestpain. Physician accuracy in interpreting potential ST-segment elevation myocardialinfarctionelectrocardiograms. EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG.
Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chestpain. Why is there this notion that myocardialinfarction cannot be diagnosed in the setting of ventricular paced rhythm?
A 70-year-old man calls 911 after experiencing sudden, severe chestpain. Electrocardiographic Manifestations: Acute posterior wall myocardialinfarction. Posterior myocardialinfarction: the dark side of the moon. This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! J Emerg Med 2001; 20:391-401.
Written by Jesse McLaren Two 70 year olds had acute chestpain with nausea and shortness of breath, and called paramedics. Accuracy of OMI findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardialinfarction. Who needs the cath lab? Int J Cardiol Heart Vasc 2021 2. Aslanger et al. Lemkes et al.
Background Patients with low HEART (History, Electrocardiogram, Age, Risk factors, and Troponin level) risk scores who are discharged from the emergency department (ED) may present clinical challenges and diagnostic dilemmas. All the patients underwent NISI (involving myocardial perfusion imaging/stress echocardiography).
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
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chestpain radiating to the left arm, associated with nausea. Echo showed new anterior regional wall motion abnormality and decrease EF from 60% to 45%. Clin Cardiol 2022 4.
Electrocardiogram (ECG) might not always show abnormalities, and chestpain is not always present. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region.
A 61 year-old with chestpain arrived to the ED by ambulance with resolving chestpain. Safety of Computer Interpretation of Normal Triage Electrocardiograms. The chestpain is resolving, so if these are resolving hyperacute T-waves, then followup ECGs should show their size diminishing.
Cardiovascular consultation had been requested for all of the patients based on their primary clinical examination, vital signs, and electrocardiogram (ECG). Additionally, 2D transthoracic echocardiography (TTE), and myocardial injury serum biomarkers assays (creatine phosphokinase-MB [CPK-MB] and cardiac troponins [cTn]) were measured once.
This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chestpain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.
Cardiology Board Review Question A 48-year-old female with no known medical history presents with acute substernal chestpain. D) An electrocardiogram is most commonly normal in these patients. Patients typically present with acute chestpain, shortness of breath, or syncope. What is Takotsubo Cardiomyopathy?
Case presentation:A 64-year-old man presented with one day of chestpain. Electrocardiogram (EKG) was unremarkable. TTE showed a reduced EF with multiple segmental abnormalities concerning for myocardialinfarction. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024.
BACKGROUND:The HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) can be used with high-sensitivity cardiac troponin to risk stratify emergency department patients with possible acute coronary syndrome. These findings support the use of a modified hs-HP to improve chestpain care.
A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chestpain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.
This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chestpain. link] Here is the history: A 30 yo man presented complaining of severe chestpain.
The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardialinfarction. We record ECGs in triage on every patient with chestpain, and some other indications, and this amounts to 8000 ECGs in triage each year, costing at most $200,000 (8000 x $20.00). October 2018.
He was asked multiple times about chestpain or dyspnea, but repeatedly denied any such symptoms. Patient denied chestpain on initial review of symptoms. Was now endorsing chestpain which began 30 minutes ago. Upon further questioning, he states that he has had intermittent chestpain since yesterday.
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.
As myocardialinfarction (MI) and many other diagnoses (for example left ventricular hypertrophy, prior MI etc.) can cause ST-segment elevation (STE) on electrocardiogram (ECG), the distinction between them may be hard and complicated. At each step, you will also find active links to the original publications.
At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute MyocardialInfarction in the Emergency Department Case 1. Widimsky P et al. J Electrocardiol 2012;45:487-90.
A 36 yo male smoker presented to the ED with chestpain. It had started the night before as "indigestion" and had progressed to 8/10 substernal chest pressure radiating to the right shoulder/jaw associated with diaphoresis, nausea, and SOB. This was sent to me by a reader named Aaron. Here is a 15 lead ECG: Sinus rhythm.
Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardialinfarction. International Journal of Cardiology Heart & Vasculature Case A 40-year-old man presents with excruciating back pain which has started 1 hour ago. References 1.
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chestpain and shortness of breath. Early Continuous ST Segment Monitoring in Unstable Angina: Prognostic Value Additional to the Clinical Characteristics and the Admission Electrocardiogram. mm STE in V1 and 1.5-2.0
The finding of dynamic ST-T wave changes on serial tracings in association with a change in chestpain symptoms ( SEE My Comment in the July 21, 2020 post ). Any ST elevation in inferior leads that occurs in association with mirror-image opposite ST depression in lead aVL. ST depression that is maximal in leads V2-to-V4.
Case A 43 year old male with a history of DM II, hyperlipidemia, and a family history of myocardialinfarction presented to a family clinic with two days of epigastric pain that started after consuming a meal. He described the pain as a “crushing and discomforting” feeling with no radiation. Normal EKG”. Normal ECG.
A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chestpain for 1.5 Appearance of abnormal Q waves early in the course of acute myocardialinfarction: implications for efficacy of thrombolytic therapy. hours when she called 911. These do NOT indicate late, subacute MI.
She went on to describe her chestpain as a "buffalo sitting on my chest" and a "weird" sensation in her jaw for 1 hour prior to arrival, associated with lightheadedness and diaphoresis. The patient was given fentanyl initially for chestpain with minimal effect and then vomited which was followed by zofran and famotidine.
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chestpain to Dr. McLaren. All electrocardiograms (ECGs) and coronary angiograms were blindly analyzed by experienced cardiologists.
A 40 something otherwise healthy man presented with substernal chestpain. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. It had occurred once 3 days prior and resolved without any medical visit. What do you think? This ECG is DIAGNOSTIC of acute LAD Occlusion. Am J Emerg Med.
Cardiology felt her chestpain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardialinfarction in the emergency department. Below are two examples of this.
Written by Jesse McLaren Two patients presented with acute chestpain, and below are the precordial leads V1-6 for each. Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review. McLaren, Meyers, Smith and Chartier. Acad Emerg Med 2023 3.
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.
BackgroundAcute myocardialinfarction commonly occurs in patients with coronary artery disease, but rarely, it can develop under a hypercoagulable state. These thrombotic complications predominantly arise in veins rather than in arteries.
She did not even need to ask in this case, because even if the patient presented with chestpain, she would call it NEGATIVE. Puskarich Abstract Objectives Data suggest patients suffering acute coronary occlusion myocardialinfarction (OMI) benefit from prompt primary percutaneous intervention (PPCI).
BackgroundAcute myocardialinfarction (AMI) is one of the most serious complications of acute type A aortic dissection (ATAAD) and markedly increases patient mortality. The 12-lead electrocardiogram revealed ST-segment depression, myocardial enzyme levels were significantly elevated.
The patient contacted the ambulance service after he experienced sudden onset chestpain and diaphoresis that had started 20 minutes prior. The de Winter electrocardiogram pattern is an infrequent presentation, reported to occur in 2% to 3.4% of patients with anterior myocardialinfarction ( 1 ).
Written by Pendell Meyers, sent by anonymous, with additions by Smith A man in his 40s had acute chestpain and called EMS. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardialinfarction: is the slope of the curve the shape of the future? JAMA [Internet] 2005;293(8):97986.
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