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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.
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.
A 50-something man presented in shock with severe chestpain. Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. A 12-lead electrocardiogram, lead V4R , and leads V7-9 were recorded on admission. His prehospital ECG was diagnostic of inferior posterior OMI.
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.
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. So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent.
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.
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. Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Chestpain and a computer ‘normal’ ECG.
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 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.
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 attending provider wrote “Agree with electrocardiogram interpretation”. No patient with chestpain should be sent home without troponin testing. All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. Normal EKG”.
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. It was stented.
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.
Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. International Journal of Cardiology Heart & Vasculature Case A 40-year-old man presents with excruciating back pain which has started 1 hour ago. Aspirated thrombotic material.
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.
The patient contacted EMS after a few hours of chestpain that started 5:30 AM. The pain was described as 6/10 radiating to the right shoulder. The chestpain was described as both sharp and pressure like. The culprit lesion was opened and stented. Below is the post -PCI electrocardiogram.
A 40 something otherwise healthy man presented with substernal chestpain. They were stented. 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? The peak troponin was 1863 ng/L.
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 Myocardial Infarction in the Emergency Department Case 1. Updates on the Electrocardiogram in Acute Coronary Syndromes.
Cardiology felt her chestpain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. A mid-LAD culprit lesion was identified and stented. Below are two examples of this. Type II MI), however decided to pursue coronary angiogram out of an abundance of caution.
A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chestpain for 1.5 It was treated with and dual "kissing balloons" and drug eluting stents. Prognostic significance of the initial electrocardiogram in patients with acute myocardial infarction. hours when she called 911.
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% At cath there was a 100% proximal LAD occlusion, which was opened and stented.
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