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Paroxysmal AV Block
A 69 year old woman with a history of congestive heart failure and stroke presented to the emergency room with sudden onset lightheadedness leading to a fall at the grocery store and sustaining head trauma. On physical examination, she was alert and in mild distress. Her HR was 72 beats per minute and blood pressure was 196/70. A 12 lead electrocardiogram (ECG) showed normal sinus rhythm, first degree atrioventricular (AV) block and right bundle branch block. She was admitted for management of subdural hematoma which was noted on CT scan.
Source: The American Journal of Medicine - December 7, 2022 Category: General Medicine Authors: Tharian S. Cherian, Amit Thosani Tags: ECG image of the month Source Type: research

Polycythemia Vera Presenting as ST-Segment Elevation Myocardial Infarction
An 80-year-old woman with a history of hypertension, pre-diabetes, chronic kidney disease (stage 3b), and a remote ischemic stroke without residual deficits presented to the emergency department complaining of several hours of epigastric discomfort and malaise. An electrocardiogram (EKG) performed at triage revealed normal sinus rhythm with>1 mm ST segment elevation in leads V4-6 and lead 1, reciprocal ST depression in aVR, and Q waves in V1 and V2 (Figure 1). The troponin I was elevated to 1.66 ng/mL (reference range
Source: The American Journal of Medicine - March 31, 2022 Category: General Medicine Authors: Eric Hirsch, Lindor Qunaj, Azeem Latib, Benjamin Galen Tags: Diagnostic Dilemma Source Type: research

The case of the furtive finding: atypical atrial flutter
A patient’s arrhythmia was identified only after an electrocardiogram (ECG) lead was attached directly to an atrial epicardial lead. The 87-year-old man had a history of paroxysmal atrial fibrillation, coronary artery disease, and severe mitral and tricuspid regurgitation and was admitted for corrective cardiac surgery. His history included a cardioembolic stroke 10 months prior to admission, hypertension, and hyperlipidemia. He underwent coronary artery bypass grafting (CABG) to the right coronary artery, bioprosthetic mitral valve replacement, tricuspid annulus repair, and a maze cryoablation or cryomaze procedure.
Source: The American Journal of Medicine - July 31, 2014 Category: Journals (General) Authors: Jeffrey Paulsen, Gagan Singh, Uma Srivatsa, Ezra A. Amsterdam Source Type: research

The Case of the Furtive Flutter: Atypical Atrial Flutter
A patient's arrhythmia was identified only after an electrocardiogram (ECG) lead was attached directly to an atrial epicardial lead. The 87-year-old man had a history of paroxysmal atrial fibrillation, coronary artery disease, and severe mitral and tricuspid regurgitation; he was admitted for corrective cardiac surgery. His history included a cardioembolic stroke 10 months prior to admission, hypertension, and hyperlipidemia. He underwent coronary artery bypass grafting (CABG) to the right coronary artery, bioprosthetic mitral valve replacement, tricuspid annulus repair, and a maze cryoablation or cryomaze procedure.
Source: The American Journal of Medicine - July 31, 2014 Category: Journals (General) Authors: Jeffrey Paulsen, Gagan Singh, Uma Srivatsa, Ezra A. Amsterdam Tags: ECG image of the month Source Type: research