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Pacemaker Malfunction

8/24/2015

0 Comments

 
HPI:
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.

EKG:
Picture
Question:
What's going on with this pacemaker? Is the malfunction the cause of her symptoms?
0 Comments

Is This Sinus?

8/17/2015

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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.
Picture
Question: 
  • What does this EKG tell you about the etiology of this patient’s lower extremity edema?
  • Is this EKG in sinus rhythm?


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STEMI Without The "STE"

8/10/2015

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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.
Picture
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?
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Not Your Average Syncope

6/30/2015

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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:

ECG:
Picture
Question:  
-What kind of block is this patient in?  
-If the EKG is unchanged from previous, does this patient still require admission for syncope workup?
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Nonspecific T-wave Changes....

6/22/2015

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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:
 
EKG:
Picture
QUESTION:  Are these benign T-wave changes?  What study needs to be obtained to confirm the diagnosis?
0 Comments

Short QT

6/15/2015

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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:

EKG:
Picture
Question:  What interval is abnormal in this EKG and what is the most likely lab abnormality that can be expected as the cause?
0 Comments

Is This Ischemia???

6/8/2015

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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”.

EKG:
Picture
Question:  Does this patient have a STEMI and do you need to activate the cath lab?
0 Comments

Shock or Not???

6/1/2015

0 Comments

 
HPI: Patient is a 54-year-old male presenting with palpitations and near syncope. Patient states that he was told he had a “heart problem” as a child. He was diagnosed with atrial fibrillation some 10+ years ago.
 
EKG:
Picture
Question: What is the rhythm and what is the indicated treatment?
0 Comments

Something Seems Backwards Here...

5/1/2015

0 Comments

 
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:

EKG:
Picture
Question:  What diagnosis does this patient have and what is the immediate treatment?
0 Comments

Could It Be Slow V-Tach???

4/26/2015

0 Comments

 
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 #1: 
Picture
EKG #2:  After a successful life saving intervention was performed, the following EKG was obtained.
Picture
Question:   What rhythm is the second EKG and what is the indicated treatment?
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    EM Off Service Cardiology Rotator

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • Global EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • MATCH 2022
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction