This was sent by Twitike Nthakomwa, a medical officer from Malawi who knows a lot about ECGs.Here is a 50-something patient who presented without symptoms of MI (simply a cough). Because a murmur was heard, an ECG was recorded.But this patient could easily develop reflux with chest pain, or chest wall pain, or any number of reasons
This ECG was texted to me on my phone, with the words “Asymptomatic with hyperthyroidism:” What do you think? I replied that precordial leads are misplaced and to record it again. How did I know this? There are well formed R-waves in V1, but none in V2 and V3, then they return in V4. It
Written by Pendell Meyers, with edits by Steve SmithThanks to my attending Nic Thompson who superbly led this resuscitation We received a call that a middle aged male in cardiac arrest was 5 minutes out. He was estimated to be in his 50s, with no known PMHx. He arrived with chest compressions ongoing, intubated, and
I saw “Chest pain” on the board and clicked to look at the ECG. Here it is: Much ST elevation in V2 (approx 5.5 mm at the J-point), but the QRS voltage is massive.There is “inferior” STE, but it comes after very high voltage R-waves The ST segment is about 11% of the preceding S-wave.
The OMI Manifesto A collaboration by Dr. Smith’s ECG Blog and EMCrit Pendell Meyers, MD Scott Weingart, MD, FCCM Stephen Smith, MD The current guideline-recommended paradigm of acute MI management (“STEMI vs. NSTEMI”) is irreversibly flawed, and has prevented meaningful progress in the science of emergent reperfusion therapy over the past 25 years. Dr. Stephen
I was reading ECGs on the computer system when this one came up: What do you think? There is apparent ST elevation in III, with reciprocal ST depression in aVL. At first glance, it looks like an inferior STEMI. It also has a wavy pattern reminiscent of hypokalemia. See these cases: Prehospital Ventricular Fibrillation in
Two CasesMale Patient I was handed this ECG of a 40-something male patient. It was recorded at triage. The chief complaint was “chest pain.” The computer interpretation was “Nonspecific”What do you think? Female Patient At the exact same time, I was viewing the computer queue of unconfirmed ECGs (read by computer but not yet overread
Written by Pendell Meyers, edits by Steve Smith A female in her 60s with history of CAD s/p PCI and CABG, alcohol abuse, and recurrent pancreatitis presented at 14:55 complaining of sudden onset epigastric pain. Initial vital signs were heart rate 44 bpm, respiratory rate 16, BP 143/67, SpO2 96% on room air. On initial
This was contributed by one of our fine interns, Aaron Robinson. A 40-something male cancer patient presented to clinic for a routine follow up and stated he was feeling “tired.” He was just finishing a course of antibiotics for bacteremia. His BP was found to be 60 systolic with a heart rate in the 170s.