A 70-something presented with stuttering chest pain for a couple days that became constant shortly before presentation to the ED. I was shown this ECG and asked for my opinion: What do you think? I did not know there was a previous to compare with (see below). I said: “There is a ventricular paced rhythm
This was texted to me, by a recent residency graduate, with the following information: “70-something w hx of TAVR (aortic valve replacement) and Stroke. SVT w/aberrancy or VT?” What do you think? Here is what I texted back: “SVT. Give adenosine.” Response: “How did you tell?” My answer: “Very rapid initial part of the QRS.
I was shown this ECG with the history that the patient had chest pain: What do you think? This is what I said: “This is not anterior STEMI; it is normal variant, though it is unusual in appearance.” If you wanted to use the formula, the computerized QTc on all ECGs was 360 ms –
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