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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 ).

EKG/ECG 195
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An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. EKG on arrival to the ED is shown below: What do you think? ng/mL (consistent with prior baseline), and a repeat EKG was obtained 1 hour after the initial EKG. or basilar ischemia.

EKG/ECG 94
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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. And she learned it well: She is not highly confident, but she does diagnose OMI. Here is a similar case from Pendell: This ECG was handed over at triage. A value above 18.2 (LAD A value above 19 is about 97% specific for LAD OMI.

EKG/ECG 109
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Massive Hemoptysis

EM SIM Cases

He previously served as Deputy Medical Director at Andersen Simulation Center, the largest simulation center in the US Army as well as the Simulation Director for Madigan Army Medical Center’s Department of Emergency Medicine Residency. His initial presentation will respond to traditional therapies for COPD exacerbation.

COPD 52
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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. There is some upwards concave ST segment elevation in the inferior leads with what seems to be well formed J-waves. First troponin I returned 3174 ng/l, at which point a repeat ECG was ordered. Not much difference from 1st ECG.

EKG/ECG 92
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Are these Wellens' waves?

Dr. Smith's ECG Blog

An ECG was texted to me (Smith) without any clinical information: What did I say? This clinical information followed: "The patient had a COPD exacerbation with a prehospital SpO2 of 60%. This clinical information followed: "The patient had a COPD exacerbation with a prehospital SpO2 of 60%. This is NOT Wellens.

EKG/ECG 52
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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). It is our goal. Thanks for your support. It has been amazing.