A middle-aged man had syncope. This ECG was recorded prehospital; here are the limb leads: What do you think? Notice that there are inverted P-waves and a very short PR interval. This is a junctional rhythm with retrograde P-waves that come slightly before the QRS. Otherwise, it is unremarkable. Here are the Precordial leads: What
A young man presented after a stab wound to the chest. Rapid ED diagnosis of cardiac penetrating trauma was made by ED ultrasound, and the patient went to the OR and had a wound to the right atrium repaired. There was no laceration of any coronary vessel. He did well. Because of tachycardia, this ECG
A middle-aged male complained of chest pain and called 911. 3 prehospital ECGs were recorded. Here is the time zero ECG: Just some non-diagnostic T-wave abnormalities T-wave inversion in V2 is a bit abnormal, and frequently seen in posterior MI, but not diagnostic. There is tiny bit of ST depression in V3 and V4 which is
Written by Pendell Meyers, with edits from Steve Smith I was charting at my computer on a busy overnight shift when a triage ECG was placed between my face and computer screen, asking for my signature. Here it is: What do you think? –Sinus rhythm.–There is a tiny amount of STE in the inferior leads,
Thanks to one our great HCMC nurses, Ryan Burch. He figured this one out. A dialysis patient presented with dyspnea. He was a bit fluid overloaded and not hyperkalemic. This ECG was recorded: This was sent to me in a text that woke me from sleep, but not simultaneous with patient care.Truly bizarre T-waves in
This post was written by one of our fantastic Hennepin County Medical Center Emergency Medicine interns who is an ECG whiz, Daniel Lee. A man is his late 50’s presents to the ED with 1 hour of post exertional chest pressure associated with diaphoresis and nausea. He has a history of known CAD, diabetes, and
Written by Pendell Meyers, of the Stony Brook class of 2019, with edits by Steve Smith Two Cases Imagine that two patients present simultaneously to your Emergency Department with moderately concerning chest pain and the following ECGs (no priors available). The first patient has this ECG: The second patient has this ECG: Do either of
A 40-something male presented with epigastric pain. An ECG was recorded immediately (time zero): This was texted to me asking for my opinion.What do you think? My answer: Normal variant He had serial ECGs: This was recorded at t = 40 minutes: Subsequently, the patient was diagnosed with cholecystitis. This was recorded at t =
I was reading through ECGs on the system when I saw this one: Sinus tachycardia, rate 120Computerized QTc = 380 msWhat do you think? I was immediately worried about a proximal LAD occlusion. Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory
A middle-aged male diabetic who is otherwise healthy was found unconscious by his wife, with incontinence. He quickly awoke but was too weak to stand. Initial vitals by EMS were BP 100/50 with pulse of 80 and normal glucose. He remained weak and somnolent, and without focal neurologic abnormality. He recovered full consciousness, but still
