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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.
A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chestpain. Symptoms other than chestpain (malaise, cough in a cancer patient) 2. PR depression, which suggests pericarditis 4. Here is that ECG: What do you think? There is sinus tachycardia.
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.
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.
Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?
In this ECG Cases blog we look at 10 cases of patients with chestpain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.
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?
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. So everything about this ECG screams acute PE.
He reports significant chestpain at the base of his scapula on the right side along with new shortness of breath. The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure. Wellen's waves indicate that, when the patient was having chestpain, there was occlusion. A 70-something y.o.
Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chestpain and shortness of breath at home in front of his family. CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time.
Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chestpain. A new right bundle branch block in a sick patient with chestpain and/or shortness of breath is a worrisome finding concerning for LAD occlusion or significant pulmonary embolism.
A man in his 60's presented after 4 days of chestpain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP).
A man in his 60's presented after 4 days of chestpain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP).
ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of ChestPain and Dyspnea Head On Motor Vehicle Collision. Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. ST depression. Myocardial Contusion?
You do NOT see this in normal variant STE, nor in pericarditis. 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”.
Written by Pendell Meyers, edits by Smith Two patients presented with acute chestpain/pressure. Chest x-ray was read as normal. CT pulmonary angiogram was negative for pulmonary embolism. Two patients with chestpain. In a patient with chestpain — this is simply not a "normal" ST-T wave in lead V2.
Given her reported chestpain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. She was noted to be tachycardic and her heart sounds were distant on physical exam.
Written by Jesse McLaren Two patients presented with acute chestpain, and below are the precordial leads V1-6 for each. The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” But ECG #1 is not "normal".
Written by Pendell Meyers A woman in her 40s presented with acute chestpain and shortness of breath. Smith : This is classic for pulmonary embolism (PE). Acute pulmonary embolism was confirmed on CT angiogram: The patient did well. Chestpain, SOB, Precordial T-wave inversions, and positive troponin.
Scenario 1 : The patient presents with 24 hours of substernal chestpain. The exception is with postinfarction pericarditis , in which a completed transmural infarct results in inflammation of the subepicardial myocardium and STE in the distribution of the infarct, and which results in increased STE and large upright T-waves.
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