This case was sent by Jessica Carmichael, and Emergency Physician on active duty at Irwin Army Community Hospital in Fort Riley, Kansas. She trained at Brooke Army Medical Center. ECG and Case I was sent this ECG with some information, but I looked only at the ECG before reading the text: What do you think?
This patient with diabetes, but no other health problem, presented after a large insulin overdose. What finding fits with insulin overdose?And how does it help to manage the patient? Answer: There are down-up waves in several leads, especially V3. The upright part is a U-wave, not a T-wave. The diagnosis is hypokalemia. K was confirmed
Written by Pendell Meyers, with edits by Steve Smith A man in his 60s with history of CAD s/p PCI, HTN, presented with chest pain which started while doing construction on his house several hours prior to arrival. Here is his ECG on arrival at 2052: What do you think? Should you activate the cath
The source of this case is anonymous.A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to “both axilla” as well as the upper back. She was reportedly “pacing in her room while holding her chest”. The initial tracing (EKG 1) was
This patient presented with altered mental status and was thought to be intoxicated. He did not have any other apparent medical issues. I’m not certain why an ECG was recorded, but it was: The computer and the overreading physician diagnosed “Sinus rhythm with LVH.”What is it? This is an accelerated idioventricular rhythm (AIVR). There is
A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. He had an ECG in clinic which worried the providers because of possible inferior MI, and they sent him to the ED. Here is that ECG: What do you think? There is sinus tachycardia.There is ST Elevation
This case and discussion is written by Sam Ghali (@EM_RESUS), with a few edits by Smith Case A 75-year-old man collapses to the ground in cardiac arrest while shopping with his wife. Medically trained bystanders happen to witness the event and begin CPR right away. Paramedics rush to the scene and find the man to
This is a middle-aged male with h/o with a history of heart failure with severely reduced ejection fraction due to dilated ischemic cardiomyopathy (EF 5-10%), probably with some component of non-ischemic cardiomyopathy, with h/o CABG, who is status post ICD placement (and previous appropriate shocks for VT) and biventricular pacer (“cardiac resynchronization therapy”), who is on amiodarone
Submitted by Alex Bracey, with edits by Pendell Meyers and Steve SmithA female in her 70s with PMH of hypertension, coronary artery disease, and a remote history of an aortic valve replacement was brought into the ED after being found down by her son. On arrival she was confused. Her initial ECG is shown below.
A middle-aged woman with idiopathic cardiomyopathy and biventricular failure, with previous EF of 15%, presented with sudden onset severe substernal chest pain. She had LBBB with a wide QRS, and therefore was a candidate for biventricular pacer for cardiac resynchronization, but when they had inserted her pacemaker, they could not get the LV lead into place (technical