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SGEM#370: Listen to your Heart (Score)…MACE Incidence in Non-Low Risk Patients with known Coronary Artery Disease

The Skeptics' Guide to EM

Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain. His father had a minor heart attack at the age of 63. With a negative initial troponin, this gives him a HEART score of 4. If we thought about ACS, we brought them in. AEM June 2022.

Coronary 100
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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

He reportedly told his family "I think I'm having a heart attack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. CPR was initiated immediately. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation.

ACS 52
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A man in his 70s with chest pain

Dr. Smith's ECG Blog

He stated it was similar to prior heart attacks. About an hour later, he was then found on the floor in cardiac arrest in the ED. ST depression maximal in V1-V4, in the context of ACS symptoms and unexplained by QRS abnormality or tachydysrhythmia, should be considered posterior OMI until proven otherwise.