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This results in severe chestpain or discomfort, with the subsequent release of cardiac biomarkers, and alterations in the electrocardiogram. The average hospital stay was 8.51 (SD7.2) days while In-hospital mortality was 8.8%. were male, with the average age of 56.313.5
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.
A young woman presented with acute chestpain. The interventionalist and cath team came to the hospital, and when the interventionalist saw the ECG, he inquired further and elicited a family history of Brugada syndrome. This case came from a friend whose sister was the patient. This was her presenting ECG: What do you think?
For example, considering whatever symptoms that the patient may have had ( ie, chestpain, palpitations, shortness of breath, etc. ) — what this might mean in view of the ECG we are looking at. The patient arrested outside the hospital. KEY Points: Use of this systematic 2-Step approach does not slow you down.
The patient was a middle-aged female who had acute chestpain of approximately 6 hours duration. The pain was still active at the time of evaluation. The patient survived the hospitalization. See some relevant cases below: Chestpain with anterior ST depression: look what happens if you use posterior leads.
This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System. The patient presented to an outside hospital An 80yo female per triage “patient presents with chestpain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB.
Written by Jesse McLaren A healthy 75 year old developed 7/10 chestpain associated with diaphoresis and nausea, which began on exertion but persisted. Below is the first ECG recorded by paramedics after 2 hours of chestpain, interpreted by the machine as “possible inferior ischemia”. 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 ). Despite active CP — cath lab activation was deferred and this patient was transported to a local hospital without PCI capability.
A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chestpain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. At times the pain does go to his left neck. It is a ssociated with mild dyspnea on exertion.
I was working at triage when the medics brought this patient who is 65 yo and has had chestpain for 12 hours. This was a weekend late evening, and so it took time the cath team to get in to the hospital. They recorded a prehospital ECG at 2112 and said that it was “normal”. So I uncrumpled it: What do you think?
A 54-year-old male athlete was evaluated at this hospital because of exertional dyspnea and chestpain. Physical examination revealed jugular venous distention and Kussmauls sign. A diagnosis was made.
He was intubated in the field and sedated upon arrival at the hospital. He did not remember whether he had experienced any chestpain. At his family's request, he was transferred to a hospital closer to his home to continue care. When EMS arrived the patient was in ventricular fibrillation. He was admitted to cardiology.
Click here to sign up for Queen of Hearts Access Case A 58-year-old woman presented to the ED with burning chestpain that started 2-3 hours earlier while sitting on a porch swing. In any case, it is diagnostic of OMI in a chestpain patient. The family filed a lawsuit against the physician and the hospital.
Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chestpain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity.
It is not always possible to be certain about the origin of chestpain just by its characteristics as the variation between individuals is quite a bit. A medical opinion should be sought in case of any significant chestpain so that important ailment is not missed. A pain lasting more than 30 minutes is usual.
Written by Jesse McLaren Three patients presented with acute chestpain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think?
Written by Jesse McLaren Two patients in their 70s presented to the ED with chestpain 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. The patient had a protracted hospitalization and did not survive.
Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization): The patient is 40 years old and presented to another hospital with chestpain and SOB. Probably because of a high troponin with chestpain.
Despite ChatGPT's reported ability to pass medical exams, new research indicates it would be unwise to rely on it for some health assessments, such as whether a patient with chestpain needs to be hospitalized.
The following ECG is obtained on arrival before the patient is hospitalized for pyelonephritis, chestpain, and syncope: Case ECG Before watching this week’s video. She is also noted to be febrile at triage, with reported malaise, vomiting, and unilateral back ache. Would you have activated the cath lab?
Methods We retrospectively analyzed the measurements at rest for 191 patients with acute chestpain (ACP) magnetocardiographically. All included ACP patients were recruited in 2009 at Yonsei University Hospital and were followed up until 2022. Results During half of the follow-up period (6.5 years), 11 patients died.
Contemporary data on recurrent AMI and its association with return emergency department (ED) visits for chestpain are needed. Methods This Swedish retrospective cohort study linked patient-level data from six participating hospitals to four national registers to construct the Stockholm Area ChestPain Cohort (SACPC).
Sent by anonymous, written by Pendell Meyers A man in his 60s presented with acute chestpain with diaphoresis. Admitted to the hospital service for further evaluation and management." The Importance of the History: As noted above — the onset of chestpain in today's case was acute.
A 40-something woman called 911 in the middle of the night for Chestpain that was intermittent. On arrival, she complained of severe pain. The medics had recorded this ECG and were uncertain whether it was recorded during chestpain: Let's get a better image with use of the PM Cardio app : What do you think?
There were no injuries and no chestpain and he appeared well. He complained of 3 days of diarrhea and abdominal pain. Pretest probability: Especially when there is no Chestpain, or there are very atypical symptoms, one should be very suspicious of the diagnosis of coronary occlusion unless the ECG is crystal clear.
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.
Sent by Drew Williams, written by Pendell Meyers A man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chestpain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin.
52-year-old lady presents to the Emergency Department with 2 hours of chestpain, palpitations & SOB. Without them the diagnosis is often tough and one must often rely on other clinical data- serial ECG’s, troponin, on-going chestpain, etc. This was written by Sam Ghali ( @ EM_RESUS ), with a few edits by me.
This was sent to me by a former resident from a community hospital: A middle-aged woman complained of chestpain and was seen in triage. She had a ECG recorded. The computer interpreted the ECG (GE Marquette 12 SL) as: "Sinus Bradycardia. Normal ECG." It was not seen by a physician. And the computer will not help you.
No prior exertional complaints of chestpain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chestpain. 24 yo woman with chestpain: Is this STEMI?
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chestpain for 3 hours prior to arrival. At this time he reported ongoing chestpain and was given aspirin and nitroglycerin.
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.
A middle aged male presented at midnight after 14 hours of constant, severe substernal chestpain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. It was not relieved by anything. He had no previous medical history. This includes: 1.
This is a previously healthy male teenager who was awoken by chestpain. He was seen at another hospital and found to have a slightly elevated troponin, then underwent a CT pulmonary angiogram (PE) protocol which revealed a right sided pneumonia. In the evening, he became diaphoretic and complained of 9/10 continuous chestpain.
I do not know if this patient has a history of cardiac disease or a recent complaint of chestpain, but T wave inversion and some biphasic T waves makes me think of reperfusion changes, reflecting a recent M.I. We do not have followup on this patient's hospital course or treatment.
I do not know if this patient has a history of cardiac disease or a recent complaint of chestpain, but T wave inversion and some biphasic T waves makes me think of reperfusion changes, reflecting a recent M.I. We do not have followup on this patient's hospital course or treatment.
A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chestpain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.
Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chestpain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. So the patient can be diagnosed with acute MI and has recurrent chestpain. What do you think?
Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chestpain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). Amazingly, he did not suffer any serious complication in hospital.
There is a patient with persistent chestpain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chestpain patient. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Is there STEMI?
Written by Jesse McLaren, with comments from Smith and Grauer A 60 year old presented with three weeks of intermittent non-exertional chestpain without associated symptoms. A prospective validation of the HEART score for chestpain patients at the emergency department. Backus BE, Six AJ, Kelder JC, et al.
== MY Comment by K EN G RAUER, MD ( 9/17/2020 ): == Todays patient is a previously healthy, 60-something year-old woman who presented with chestpain that began at a reception. We are indebted to Dr. Smith for developing Modified Smith-Sgarbossa Criteria for assessing ST-T wave changes in chestpain patients with LBBB.
Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chestpain and shortness of breath after finishing a 4-mile run. His symptoms of chestpain and shortness of breath were attributed to an asthma exacerbation during exercise.
This case was sent by Dr Avinash Krishnamurthy, a fine emergency medicine resident from Australia Cairns base hospital Case : An adolescent male had a mechanical fall and injured his left shoulder and arm. There was apparently no syncope and he had no bony injuries, but he did complain of left sided chestpain.
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