Remove Echocardiogram Remove Pericarditis Remove Tachycardia
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Acute chest pain and ST Elevation. CT done to look for aortic dissection.

Dr. Smith's ECG Blog

This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. Mistaking OMI for pericarditis is a much more harmful error than the converse. The rate is tachycardic, which is uncommon in OMI and common in pericarditis.

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"Pericarditis" strikes again

Dr. Smith's ECG Blog

mm has been described in normal subjects) Overall impression: In my opinion and experience, this ECG most likely represents a normal baseline ECG, but with a small chance of pericarditis instead. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant."

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Chest Pain and Inferior ST Elevation.

Dr. Smith's ECG Blog

There is sinus tachycardia. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology. I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. PR depression, which suggests pericarditis 4.

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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Hopefully a repeat echocardiogram will be performed outpatient. The Initial ECG in Today's Case: As per Dr. Meyers — the initial ECG in today's case shows sinus tachycardia with bifascicular block ( = RBBB/LAHB ).

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Echocardiogram showed severe RV dilation with McConnell’s sign and an elevated RVSP. Dyspnea, Chest pain, Tachypneic, Ill appearing: Bedside Cardiac Echo gives the Diagnosis 31 Year Old Male with RUQ Pain and a History of Pericarditis. and tachycardia, 1.8. The patient was upgraded to the ICU for closer monitoring.

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Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

We can see enough to make out that the rhythm is sinus tachycardia. Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW.

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Three prehospital ECGs in patients with chest pain

Dr. Smith's ECG Blog

These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. Elevated troponins prompted an echocardiogram — which revealed an apical wall motion abnormality (WMA). Usually with pericarditis and myocarditis — hyperacute T waves (HATW) are not present.