90 y/o woman h/o sick sinus syndrome, AF, and a pacemaker presents with atypical CP. Troponins are negative, CTPA is negative for PE. She denies palpitations, shock-like sensations, or chest wall contractions. Palpated HR corresponds with QRS complexes on the monitor.
What's going on with this pacemaker? Is the malfunction the cause of her symptoms?
HPI: 50 y/o male with hx of COPD, heroin use, and recently diagnosed cor pulmonale presents with 3 weeks of lower extremity edema. No chest pain, shortness of breath, or palpitations. An EKG is obtained in the emergency department.
HPI: 57 y/o woman with remote hx of CABG/PCI presents with 2 hrs of 6-10/10 substernal chest tightness and SOB. No recent cardiac events/complaints. Initial troponin is 1.48.
Question: Is this patient experiencing a STEMI despite the lack of ST elevations ≥1mm? How would you diagnose this and explain to your cardiology consultants?
HPI: 74 y/o male with history of HTN, DM, and early dementia presents to ED following a witnessed syncopal event at home. Family denies seizure activity, trauma, or anticoagulation. He is now asymptomatic and back at clinical baseline. Laboratory workup and CXR are unremarkable. EKG is shown below:
-What kind of block is this patient in?
-If the EKG is unchanged from previous, does this patient still require admission for syncope workup?
HPI: 20 y/o otherwise healthy male presents after syncopal event while playing basketball. He is athletic, plays basketball 7 days a week, and has never syncopized before. There was a prodromal sensation of “lightheadedness”, but he denies other symptoms and is asymptomatic upon ED arrival. EKG is obtained immediately:
QUESTION: Are these benign T-wave changes? What study needs to be obtained to confirm the diagnosis?
HPI: 55 y/o male with no past medical history presents with vague symptoms including nausea, lethargy, and weakness. Vital signs are within normal limits. Before labs come back you obtain this EKG:
Question: What interval is abnormal in this EKG and what is the most likely lab abnormality that can be expected as the cause?
HPI: Approximately 30 year old female with history of frequent PVCs who presents via EMS with palpitations and near syncope. She was driving on the highway when she had to stop due to abrupt palpitations, SOB, and sensation like she was about to “black out”.
Question: Does this patient have a STEMI and do you need to activate the cath lab?
HPI: Approximately 30 year old obese gentleman with 15 pack year smoking history presents with 2 days SOB, cough productive of yellow sputum, and occasional chest pain. He has a family history significant for MI at a young age so the following EKG is obtained:
Question: What diagnosis does this patient have and what is the immediate treatment?
HPI: Middle age male with no significant past medical history presented to the ED with chest pain. Patient was exercising when he developed left-sided chest pain radiating to his left shoulder. Vital signs within normal with initial EKG below:
EKG #2: After a successful life saving intervention was performed, the following EKG was obtained.
Question: What rhythm is the second EKG and what is the indicated treatment?