Pre-existing Left Bundle Branch Block and Atrial Fib: what is alarming on this routine pre-procedure ECG?

An elderly patient had a pre-procedure ECG (ECG-1).  She was asymptomatic.  The patient had known Left Bundle Branch Block (LBBB) and atrial fibrillation (see ECG-2 below), and was rate controlled on metoprolol.  ECG-1 What is the problem? ECG-2 (previous for comparison): There are enormous U-waves, best seen in V1-V3, but also in V4 and V5. 

FOAM EMCC Blogs 2018

Has the FOAM bubble burst? 2018 review of the Emergency Medicine and Critical Care (EMCC) blogs and podcasts with some surprising results The post FOAM EMCC Blogs 2018 appeared first on Life in the Fast Lane. Go to Source Author: Dr Michael Stirling Powered by WPeMatico

The Interventionalist Refuses Angiography, and even to speak to the Emergency Physician

A recent residency graduate, let’s call her “The Graduate” or “TG,” texted me these ECGs from somewhere far away across the country, in real time, in the hopes of being able to persuade the interventionalist to take the patient to the cath lab. Case An otherwise healthy middle-aged patient presented with chest pain of uncertain