Remove Chest Pain Remove Embolism Remove Ultrasound
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Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Ten days later the patient returned with worsening pleuritic chest.

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A man in his 50s with shortness of breath

Dr. Smith's ECG Blog

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Acute pulmonary embolism was confirmed on CT: The patient did well with treatment. Now another, with ultrasound. This is a quiz.

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Case Report: PROS1 (c.76+2_76+3del) pathogenic mutation causes pulmonary embolism

Frontiers in Cardiovascular Medicine

Genetic protein S (PS) deficiency caused by PROS1 gene mutation is an important risk factor for hereditary thrombophilia.Case introductionIn this case, we report a 28-year-old male patient who developed a severe pulmonary embolism during his visit. The patient had experienced one month of chest pains, coughing and hemoptysis symptoms.

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Acute artery occlusion -- which one?

Dr. Smith's ECG Blog

In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. So CT is required to find the diagnosis!

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Acute Dyspnea and Right Bundle Branch Block

Dr. Smith's ECG Blog

Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema. Finally, the presentation is dyspnea, not chest pain. What do you think? Also, we know the patient had a stent.

Aneurysm 123
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A 60-something with Syncope, LVH, and convex ST Elevation

Dr. Smith's ECG Blog

There was no chest pain or SOB at the tim of the ECG: Computerized QTc is 464 ms A previous ECG from 8 years prior was normal. My opinion was that it was not a cath lab case, but I did suggest they do a bedside ultrasound to look for an anterior wall motion abnormality. I had not seen the cardiac ultrasounds at this time.

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Abstract 4145631: A Rare Case of Sequential Impella Mechanical Failures due to Infective Endocarditis Vegetations

Circulation

Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations.