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ECG Blog #366 — Diltiazem didn't work.

Ken Grauer, MD

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( To improve visualization — I've digitized the original ECG using PMcardio ).

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Proportionality is a major element in the ECG Diagnosis of OMI.

Dr. Smith's ECG Blog

This is the result for this ECG, from MDcalc.com : The most accurate cutpoint is 18.2. Outcome: 100% LAD Occlusion Here the Queen explains why: The dark blue tells us that she is looking especially at the QRS in V3 and the T-wave in V2 and V3. Here is a similar case from Pendell: This ECG was handed over at triage.

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Chest discomfort and a dilated right ventricle. What's going on?

Dr. Smith's ECG Blog

The following ECG was recorded. The presenting ECG shows SR with narrow QRS complexes. First troponin I returned 3174 ng/l, at which point a repeat ECG was ordered. Not much difference from 1st ECG. At this point an old ECG on file was found for comparison. Upon admission she had ongoing slight chest discomfort.

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A Brilliant Comment Makes the Study of the Week

Sensible Medicine

More pertinent to your recent This Week in Cardiology podcast , patients with monomorphic ventricular tachycardia and coronary disease often have a small troponin rise and ST segment changes on their initial post-cardioversion ECG (and have established coronary disease).

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A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.

Dr. Smith's ECG Blog

A 49 year old woman with h/o COPD only presented with sudden dyspnea. Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? The ECG findings are focal to the anterior and high lateral wall.

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What is lurking underneath this new right bundle branch block?

Dr. Smith's ECG Blog

Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. Here is her triage ECG (the baseline is not available but reportedly "normal"): What is your interpretation? There is sinus rhythm with PACs and PVCs. Learning Points: 1.

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Case Report: Coronary Vasospasm-Induced Cardiac Arrest

ACEP Now

A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD), asthma, amphetamine and tetrahydrocannabinol (THC) use, and coronary vasospasm presented to triage with chest pain. During initial assessment, an ECG was obtained and revealed ST-segment elevation (STE) in the inferior leads with ST depression anteriorly.