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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 Anonymous, edits by Meyers and Smith A 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chestpain. The pain was heavy, radiated to her jaw with an associated headache. Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 Lupu L, et al.
Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. He had been awakened by cough at 3 AM 2 days earlier.
He did not have chestpain. The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Is it STEMI? Chestpain in high risk patient. Here is his triage ECG: What do you think? Are these Hyperacute T-waves? What is going on here?
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chestpain and shortness of breath. This is technically a STEMI, with 1.5 However, I think many practitioners might not see this as a clear STEMI, and would instead call this "borderline."
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.
female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chestpain for the past four hours. While she was in her bed at home, she had sudden onset of left sided chestpain that radiated to her shoulder. The pain was pleuritic, without nausea or diaphoresis.
The patient was managed in the ICU and had serial troponins. At some point he returned with chestpain, and all these findings were put into place. Many MI do not have chestpain 4. Smith noted in his Learning Points about this Case that, “Many MIs do not have chestpain”. First was 2.9
No chestpain. His inpatient clinicians did not think that an urgent angiogram was warranted given that he was chestpain free, his EKG appeared nondiagnostic, and serial troponins were not elevating beyond 2 ug/L. Patients on dialysis often do not have chestpain in the setting of acute MI. Why is this?
He denied any chestpain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". They recommended repeating his ECG and awaiting troponin since the patient did not have any chestpain. What is it?
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