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.
A middle-aged man called EMS for chest pain. This prehospital ECG was recorded: Obvious Anterior STEMI due to proximal LAD occlusion (with STE in aVL and reciprocal STD in inferior leads). On arrival to the ED, this ECG was recorded 10 minutes later: Almost all STE is gone, but the hyperacute T-waves remain While waiting
A middle-aged patient called 911 for 1 hour of chest pain. He was hemodynamically stable. Here is the prehospital ECG: Obvious inferior MI, but also with STE in V3-V6 Here is the first ED ECG: Again, inferior and lateral STEMI.Is there any right ventricular (RV) MI? 85% of inferior MI are due to RCA occlusion.
Written by Pendell Meyers A female in her 60s with COPD, DM, hypothyroidism, CAD, and severe bladder cancer presented from a nursing home with altered mental status, hypotension, hypoxia, and bradycardia. Here is her initial ECG (no prior for comparison): What do you think? Here is another ECG minutes later: There is a regular wide
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
Written by Pendell Meyers A female in her late 40s presented with chest pain, waxing and waning over the past 24 hours. Her history included end stage renal disease on dialysis, HTN, and DM. Here is her initial ECG around 4:30pm: Sinus tachycardia. The QRS is characterized by high voltage and nonspecific intraventricular conduction delay.There
Doug Brunette is one of the finest Emergency Physicians, if not the finest, whom I have ever known. He was one of the early Hennepin greats, and one of my first and best teachers. He has always been passionate about teaching and practicing Emergency Medicine. Doug’s landmark article in JAMA 1989 was my inspiration to
While I had a few moments, I was reading a series of consecutive ECGs recorded in the ED. I came across this one: The computer read was:Normal ECG The cardiologist formal overread was Normal ECG“No significant change” However, it is diagnostic. Of what? In V2-V6, the flat ST segments, sharp upturn of the T-waves, narrow
Written by Pendell Meyers, with edits by Steve Smith The VERDICT trial was recently published. This is yet another study looking at the optimal timing of cardiac catheterization in the setting of NSTEMI. Here are the key summary points of this RCT: Reference: Kofoed et al. Early Versus Standard Care Invasive Examination and Treatment of Patients
I was reading a stack of ECGs when I came across this one: What do you think? I immediately saw that this ECG is DIAGNOSTIC of hyperkalemia. There are very flat ST segments with a sharp upturn to the T-wave. The base of the T-wave is very abnormally narrow, which is what creates the peaked