Dr. Smith's ECG Blog

JUNE 17, 2024

He was started on a heparin drip and CTA of the chest was ordered to rule out pulmonary embolism. This is a case like many others posted (see list below) and the EKG from the patient’s original presentation can be quickly recognized as diagnostic for pulmonary embolism. In fact, Kosuge et al. Accessed May 28, 2024. This is a quiz.

Chest Pain 137

Chest Pain Embolism Pulmonary Tachycardia 137

Dr. Smith's ECG Blog

DECEMBER 20, 2013

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?

Pericarditis 52

Pericarditis Chest Pain Pulmonary Embolism 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time. This is a quiz.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. According to a recent systematic review and meta-analysis, spontaneous type 1 ECG had 2.4%

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

This is a bad ST vector orientation, because it causes widespread STE and one of the most important mistakes that needs to be avoided here is thinking of the diagnosis of pericarditis. Such an out-of-proportion STE is virtually never seen in pericarditis. Look at the STE in lead II, aVF. Aslanger as one of the co-authors ).

Chest Pain 52

Chest Pain Myocardial Infarction Blog Pericarditis 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

The combination of findings consistent with acute coronary occlusion in the anterior and inferior leads is likely due to a large "wraparound" LAD occlusion, should not be confused with the "diffuse" ST elevation of pericarditis, and will usually show reciprocal ST depression in aVL.

Chest Pain 52

Chest Pain Pericarditis Embolism Stent 52

Dr. Smith's ECG Blog

MARCH 11, 2016

Both of these are very suggestive of " No-Reflow ," or poor microvascular reperfusion due to downstream embolization of microscopic platelet-fibrin aggregates. MYOCARDIAL RUPTURE AND POSTINFARCTION REGIONAL PERICARDITIS KEY POINTS · Myocardial rupture occurs in 1 to 1.5% Myocardial Rupture and Postinfarction Pericarditis.

Myocardial Infarction 52

Myocardial Infarction Pericarditis Angina STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

Patients with completed, transmural infarct are also at risk for post-infarction regional pericarditis and myocardial rupture. LV aneurysm puts them at risk for a mural thrombus, which puts them at risk for embolism, especially embolic stroke. Peak Troponin and Infarct Size: 60 ng/mL would be a very high first troponin.

Aneurysm 52

Aneurysm Ischemia Embolism STEMI 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

The "flu-like" illness suggests myo- or pericarditis, but that would be a diagnosis of exclusion. Then, part of the thrombus embolized into the LCx causing an inferoposterolateral OMI. (As Do not wait for the troponin; a lot of myocardium will be dead if you do. The case continues.

Chest Pain 64

Chest Pain Blog Critical Care Arrhythmia 64

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, 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.

Chest Pain 52

Chest Pain STEMI Blog Pericarditis 52

Dr. Smith's ECG Blog

JANUARY 12, 2023

CT pulmonary angiogram was negative for pulmonary embolism. If the patient continues to have reperfusion, then we would expect progressive terminal T wave inversion then full T wave inversion over time in the future ECGs. Second troponin T resulted at 1,318 ng/L. Chest x-ray was read as normal. Heparin was started. Reocclusion!

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. Pericarditis? He spent several days in the PICU, undergoing workup including: Serial troponins: rising from 5,700 ng/L (unknown if I or T) to greater than 25,000 ng/L (greater than the lab's upper limit of reporting). No further troponins were measured.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 17, 2024

The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” But STEMI criteria ignore all this and look at ST segments in isolation. Based on STEMI criteria and unhelpful computer interpretation, the patient was rushed to the cath lab.

Chest Pain 99

Chest Pain STEMI Myocardial Infarction Blog 99