A man in his 40s who really needs you to understand his ECG

 Written by Pendell MeyersA man in his 40s presented for " left sided chest pain sudden onset yesterday when sneezing and coughing that is worsened with inspiration. " He also complained of associated SOB, dizziness, jaw pain, and back pain, which he described as " muscle spasms. " He has also had rhinorrhea and cough for 1 week. Also, left hand numbness today. He went to urgent care for evaluation. An ECG was performed there (unavailable) which reportedly was abnormal, so EMS was called to urgent care to take him to the ED.On EMS arrival, they noted the patient vomited then became unresponsive. He was reportedly in PEA arrest, so they started chest compressions. After approximately 30 seconds of compressions, before the defibrillator could be applied, the patient started moving and moaning. Vitals then showed bradycardia, hypotension, and hypoexmia. He was then transported to the ED.EMS recorded an ECG and transmitted it to the ED physicians before arrival:Here is the same image after PM Cardio app processing:What do you think?It ' s an unusual and terrifying ECG. There is sinus rhythm at a rate of approximately 120 bpm with 2:1 AV block (see lead V1 where the P waves are very clear), resulting in ventricular rate near 60 bpm. The QRS shows RBBB and LAFB. There is concordant STE in V1-V5. The inferior leads have large upright T waves that are likely hyperacute, with reciprocal large volume TWI in aVL (these are more than expected for the LAFB). The T waves in V2-V4...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs