A man in his 30s with 12 hours of chest pain; is the ECG consistent with 12 hours of occlusion?

Written by Pendell Meyers, submitted by Siva Vittozzi-WongA man in his 30s with history of hypertension, hyperlipidemia, and diabetes presented with chest pain which started 12 hours prior to presentation. The pain was described as pressure, constant for 12 hours, radiating to the jaw, with left arm numbness. Initial vitals were significant for bradycardia at 45 beats per minute.Here is his presenting ECG with active pain:What do you think?Here was the prior EKG on file:The emergency medicine resident (who has received lectures from me on hyperacute T-waves, suble OMI, etc) documented the following interpretation:" Initial EKG showed hyperacute T-waves in the inferior leads, in particular lead III. These findings are suggestive of an RCA occlusion which is supported by bradycardia due to SA node ischemia. Compared to an old EKG on file, these are all new findings. "Meyers comment: So proud. Spot on. Inferior hyperacute T-waves, with negative hyperacute T-wave in aVL. The lateral leads also have minimal STE and hyperacute T-waves. Even without having the baseline ECG, I would say the inferior hyperacute T-waves are still diagnostic. With the baseline ECG in hand, it is all much easier and much more diagnostic, and you can see that the lateral leads are clearly hyperacute as well. Of note, the inferior leads may actually have STE that just barely meets criteria - it is just barely under a full 1 mm in two consecutive leads, and I believe that almost every ca...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

Related Links:

.
Source: Archives of Physiology and Biochemistry - Category: Physiology Authors: Source Type: research
.
Source: Archives of Physiology and Biochemistry - Category: Physiology Authors: Source Type: research
.
Source: Archives of Physiology and Biochemistry - Category: Physiology Authors: Source Type: research
Authors: Ye X, Gray E, Wang YF, Wang SJ Abstract Objectives: To assess the cost-effectiveness of mirogabalin versus no treatment or pregabalin in patients with post-herpetic neuralgia (PHN) from a third-party perspective in Taiwan.Methods: A Markov model, which was developed with 2-week cycles and 1-year time horizon from the Taiwanese National Health Insurance Administration perspective, consisted of three health states: 'mild', 'moderate' and 'severe' pain. Average daily pain score (ADPS) was assessed at the end of each cycle. Patients either remained in, or transitioned from, their assigned health state to a dif...
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
Conclusions: Valoctocogene roxaparvovec was found to be cost-saving-on average by about $6.8 million per patient-and more effective than prophylactic therapy for treatment of hemophilia A. The comparative benefit of gene therapy was observed across a broad range of simulated patients that were representative of the real-world severe hemophilia A population. PMID: 31971453 [PubMed - as supplied by publisher]
Source: Journal of Medical Economics - Category: Health Management Tags: J Med Econ Source Type: research
A 50-year-old man driving a motorcycle at 100 kph crashed at a curve on a racing course. On arrival, he had clear consciousness, and his vital signs showed mild hypertension and tachycardia.  His chief complaint was general pain. The only physiological fin...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Economics of Injury and Safety, PTSD, Injury Outcomes Source Type: news
Liang Wudong, 62, died after treating patients in Wuhan amid signs that health workers are overwhelmed by the outbreakA doctor treating victims infected with the coronavirus in the Chinese city of Wuhan has died from the virus amid further signs that the local health system has been overwhelmed and that the outbreak is worsening.The 62-year-old doctor Liang Wudong died on Saturday morning, state media said, and it was also reported by the Chinese Global Times website that another doctor who had been treating patients in Wuhan died of a heart attack later in the day. It was not clear if Jiang Jijun, 51, had contracted the v...
Source: Guardian Unlimited Science - Category: Science Authors: Tags: Coronavirus outbreak China Asia Pacific Science Health Source Type: news
Abstract OBJECTIVE: This longitudinal observational study examined BMI changes between successive pregnancies. METHODS: The computerized medical records of women who attended a large maternity hospital between 2009 and 2017 for their first and second singleton deliveries were analyzed. Women who had their weight first measured after 15 weeks of gestation in either pregnancy were excluded. RESULTS: Of the 9,724 women, the incidence of obesity increased from 11.6% in the first pregnancy to 16.0% in the second. The mean interpregnancy interval was 32.5 ± 15.7 months, and median BMI...
Source: Obesity - Category: Eating Disorders & Weight Management Authors: Tags: Obesity (Silver Spring) Source Type: research
AbstractPurposeTo compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding.MethodsAn IRB-approved retrospective study was conducted of 35 consecutive patients diagnosed with GI bleeding that received angiography for planned catheter-directed embolization. Of these patients, 20 were diagnosed with bleeding using a tagged RBC scan, whereas 15 were diagnosed using CTA. The lengths of time between diagnostic study order to study completion, d...
Source: Abdominal Imaging - Category: Radiology Source Type: research
Authors: Kovesdy CP, Gosmanova EO, Woods SD, Fogli JJ, Rowan CG, Hansen JL, Sauer BC Abstract Objective: Patiromer is a sodium-free, non-absorbed, potassium (K+) binder approved for the treatment of hyperkalemia (HK). Among US Veterans with HK, this retrospective, observational cohort study evaluated patiromer utilization, RAASi continuation, and K+ concentration change following patiromer initiation.Methods: Using data from the Veterans Affairs Corporate Data Warehouse, Veterans with HK (K+ ≥5.1 mmol/L) were included upon patiromer initiation (index date) during the study period (1/2016-8/2018). All patien...
Source: Postgraduate Medicine - Category: Internal Medicine Tags: Postgrad Med Source Type: research
More News: Angiography | Angioplasty | Arrhythmia | Back Pain | Blogging | Brain | Cardiology | Depression | Diabetes | Education | Electrocardiogram | Emergency Medicine | Endocrinology | Eyes | Heart | Heart Attack | Hospitals | Hypertension | Learning | Neurology | Pain | Perfusion | Study | Thrombosis | Training | Universities & Medical Training