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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. Am Heart J.
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.
He had suffered a couple bouts of typical chestpain in the last 24 hours. This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. The pain had lasted about one hour. Case A 40-something male presented to triage. There are classic Wellens' waves in V2-V5. Am Heart J.
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?
A 70-year-old man calls 911 after experiencing sudden, severe chestpain. Does routine use of the 15-lead ECG improve the diagnosis of acute myocardial infarction in patients with chestpain? This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! This is his 12-Lead ECG: What do you think? Am J Cardiol.
He reports significant chestpain at the base of his scapula on the right side along with new shortness of breath. Wellen's waves indicate that, when the patient was having chestpain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o.
The patient had experienced one month of chestpains, coughing and hemoptysis symptoms. The patient was treated with heparin anticoagulant therapy, catheter thrombus aspiration, and catheter thrombolysis. After treatment, the patient's chestpain symptoms were relieved, and there were no symptoms such as difficulty breathing.
This male in his 40's had been having intermittent chestpain for one week. He awoke from sleep with crushing central chestpain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric. Am J Cardiol (1995) 75 : pp 1206-1210.
Today’s patient presented to the ED not only with chestpain — but also with shortness of breath , therefore with a history potentially consistent with the diagnosis. When it is — this may greatly expedite clinical decision-making for anticoagulation and/or thrombolysis. The sensitivity of POC Echo is not perfect.
We present a complex case of NSTEMI with multi-vessel coronary artery disease treated with PCI via the Carlino technique.Case Description:A 60-year-old female with a history of hypertension, diabetes mellitus, and ischemic heart disease presented with severe chestpain that radiated to the neck and was associated with nausea and vomiting.
This was my thought: if this patient presented to the ED with chestpain, then this is an LAD occlusion. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chestpain. Ann Emerg Med 1998;31(1):3-11. Wang T, Zhang M, Fu Y, et al. Marti D et al.
Time window s for intervention for thrombolysis in STEMI starts from onset of chestpain, but when it comes to primary PCI, a different time window takes the center stage pushing the former to the background.
No chestpain. Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chestpain. ( The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. What is the rhythm ?
Case An elderly patient had acute chestpain and 911 was called. Blinded physicians adjudicated angiogram reports for coronary lesions and thrombolysis in myocardial infarction (TIMI) flow score. It is important for cardiologists to realize that a paramedic may see something they do not. What do you think?
link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chestpain. He described it as "10/10" intensity, radiating across his chest from right to left. This is written by Willy Frick, an amazing cardiology fellow in St.
This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. His response: “subendocardial ischemia.
In this special edition main EM Cases podcast episode we feature the highlights from live podcasts recorded at Calgary EM during their annual Hodsman Lecture Day, covering a variety of current EM topics: The challenges of posterior circulation stroke (PCIS); Emergency Physician Lead to improve ED overcrowding, access block and job satisfaction; When (..)
A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chestpain for 1.5 Patients who received CPR or experienced reinfarction or very small infarcts due to thrombolysis also displayed Type II T-wave evolution. hours when she called 911. Specificity of Type II for PIRP was 77%.
Methods In a prospective cohort study, patients with intermediate high-sensitivity cardiac troponin I concentrations (5 ng/L to sex-specific 99th percentile) in whom myocardial infarction was ruled out were enrolled and underwent coronary CT angiography (CCTA) after hospital discharge.
He contacted EMS due to acute onset chestpain and feeling unwell and fatigued. He subsequently developed worsening chestpain. This, in the context of worsening chestpain , is evidence of reocclusion of the infarct-related artery and active OMI in development. See this case: A man his 50s with chestpain.
A 30 year old African American Male presented to the ED with chestpain that occurred the day before. There was no pain on the day of presentation. 2019.06.007) (Full text here: [link] ) The ECG above is diagnostic of Wellens' syndrome (full reference below): 1) Episode of anginal chestpain that is resolved (GONE!)
The ECG in Figure-1 was obtained from a middle-aged man who presents to the ED ( E mergency D epartment ) with 6 hours of chestpain. Figure-1: The initial ECG in today's case obtained from a middle-aged man with 6 hours of chestpain. ( He is hemodynamically stable.
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