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Elder Male with Syncope

EMS 12-Lead

He denied any specific prodrome of gross palpitations, however did endorse feeling quite dizzy just before the event. Given no clinical prelude of anginal (or equivalent) descriptors, prior to the acute event, risk stratification of the ECG and Troponin was pursued via Echo and nuclear Myocardial Perfusion Imaging (MPI).

Coronary 290
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. Edited by Smith He also sent me this great case.

CAD 126
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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

Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? AEM June 2022. AEM June 2022.

Coronary 100
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Expert human ECG interpretation and/or the Queen of Hearts could have saved this patient's anterior wall

Dr. Smith's ECG Blog

A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. This history immediately places this patient in a high -prevalence population for having an acute event. This is a re-post of an excellent case from 2021. Respect physiology.

OR 127
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"Call HazMat Before Opening"

FOAMfrat

CAD notes indicate that the caller was walking in the park and came across a vehicle in the far corner of the parking lot. If you suspect that you have encountered a chemical suicide event, start your local fire and hazmat companies and have them assess and decontaminate if appropriate. Its mid-Monday morning on a crisp spring day.

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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

Stated differently, the differential diagnosis for the presenting syndrome was either ventricular fibrillation due to acute coronary syndrome, or idiopathic ventricular fibrillation and bystander stable CAD. As per Dr. Frick — "Angiography can be misleading — and must always be understood in clinical context".

Coronary 118
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A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al. Heart Rhythm, 4(2), 198-199. [6]

E-9-1-1 92