Chest pain + troponin of 1600 + LBBB + 6mm ST elevation = occlusion MI, right?
This case is by Jesse McLaren (@ECGCases), with comments by Smith and GrauerA 50 year-old with CAD and ESRD went to their regular hemodialysis appointment complaining of two days of exertional chest pain. The patient was sent to the ED when high-sensitivity Troponin I returned at 1,526 ng/L (normal<26 in males,<16 in females). They were painfree on arrival, with BP 180/70 and other vitals normal. What do you think? There ’s sinus rhythm with LBBB and appropriate discordant ST changes: there’s no concordant ST elevation, no concordant ST depression in V1-3, and no excessive discordance...
Source: Dr. Smith's ECG Blog - March 31, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A woman in her 50s with shortness of breath
Case written by Neha Ray, MD, with edits by Meyers, Smith, GrauerA woman in her 50s presented for evaluation of multiple episodes of syncope with shortness of breath. On EMS arrival, she was GCS 15 with HR 110s. En route to the ED, the patient had 4 more episodes of syncope and became hemodynamically unstable with SBP in the 80s and HR 160s. The first recorded SpO2 was 73%. On arrival to the ED, patient was diaphoretic and in extremis. Her initial EKG is below. Paramedics arrive to the ED and state that they are worried about inferior STEMI. What do you see? What do you think?The ECG shows sinus tachycardia...
Source: Dr. Smith's ECG Blog - March 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Is there evidence of OMI on this ECG?
This is another one from Amandeep ( " Deep " ) Singh, with many comments by Smith. Dept Emergency Medicine, Highland Hospital, Oakland.Case67yo male with h/o schizophrenia and who has become increasingly distrustful of Western medicine presents with chest pain radiating to the right shoulder associated with shortness of breath for 24 hours duration. He states that he was unable to sleep secondary to the pain. The patient seems very worried about his right shoulder and is requesting a x-ray. An x-ray was obtained, as well as an ECG and a troponin. Prior to the trop...
Source: Dr. Smith's ECG Blog - March 26, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Intermittent Chest pain with Nausea and Vomiting, resolved at this moment
This is fromAmandeep ( " Deep " ) Singh. Dept Emergency Medicine, Highland Hospital, Oakland.Case51 yo male who walked to a parked fire engine complaining of nausea and vomiting. Per patient, he started feeling nauseous when he woke up, and shortly after, vomited. On arrival at the emergency department, he reports that he has had intermittent episodes of chest pain associated with nausea and shortness of breath over the past 3 days. These episodes last about 20 minutes before spontaneous resolution. He states that he is no longer having any chest pain, difficulty breathing, or na...
Source: Dr. Smith's ECG Blog - March 23, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Understanding this pathognomonic ECG would have greatly benefitted the patient.
Written by Pendell MeyersInterpret this ECG first without context. You don ' t need context yet because this ECG is nearly pathognomonic.After having learned about benign T wave inversion pattern years ago on this blog, and having seen many cases on this blog and in my practice since then, I instantly recognize this as BTWI, a fairly common normal variant. I see maybe one of these ECGs each month in my practice. There is no ischemia, certainly no concern at all for OMI. It meets basically all of the criteria that Dr. Smith has consistently described over the years, after reviewing a large cohort of patients by W...
Source: Dr. Smith's ECG Blog - March 22, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
