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A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. So maybe she is better than I am.

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Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Note 1: Levels were significantly lower in takotsubo that presented with T-wave inversion. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. Learning Points: 1. What do you think? V1 has 0.5

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"Pericarditis" strikes again

Dr. Smith's ECG Blog

On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. They found non-obstructive CAD, with only a 20% stenosis of OM2 and 10% RCA. 15-9/6/2017 ). Figure-1: Excerpt from ESC review on acute pericarditis ( See text ). No acute culprit.

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40-something with severe CP. True + vs. False + high lateral MI. ST depression does not localize.

Dr. Smith's ECG Blog

Important Learning Point: "STEMI" is defined by millimeter criteria (1 mm in limb leads), which this does not meet. True Positive ST elevation in aVL vs. False Positive ST elevation in aVL Case 1. The pain improved from 9/10 to 3/10 after NTG. This is because: 1. Why did I say this? There is a down-up T-wave in aVF.

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