74 yo F with hx of CAD, afib, HLD, severe LV dysfunction is brought in by EMS as a notification for a STEMI. A 12-lead EKG in your ED shows the same as the EMS EKG. Should you activate the CATH lab? Answer: Check an old EKG. An old E…
Article Citation: Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, et al; DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003 Aug 21;349(8):733-42. PMID:…
Let’s wait for the chest x-ray they said….let’s try them on BiPAP first they said. But were they correct? REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in the Emergency Department of Acute Heart…
For our clinical pearl today I thought I thought I would do some basic ECG teaching. This is a real case that I saw with Carlo at Elmhurst in the cardiac room. As always, we will start with a clinical scenario. A middle-aged male with unkno…
You get a pop-up warning in the electronic medical record about potentially adverse interaction with a prolonged QT interval. What’s the risk, right? Afraid of a little torsades de pointes? Can’t we just give some prophylactic magnesium and…
The Right Ventricle The right ventricle (RV) has been getting more coverage lately from the Wilcox et al review article in Annals to the continued coverage in many critical care circles where anesthesia and emergency medicine overlap.(1) F…
Sgarbossa EB, Pinski SL, Barbagelata A, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7. What we already know about the…
When you examine the ECG of a patient who syncopized, what are you looking for? You’re probably checking for a prolonged QT interval, signs of left ventricular hypertrophy consistent with hypertrophic obstructive cardiomyopathy, a delta wav…
What happens when a patient’s pacemaker seems to be malfunctioning? “Call the EP fellow” should not be your only answer! Take a look at the ECG, and ask yourself if the pacemaker may be over-sensing, under-sensing, or failing to capture….
Article Citation: Wyse DG, Waldo AL, DiMarco JP, Domanski MJ, et al; Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillati…
We’ve all seen the patients roll in with EMS nasal cannula snug against their nares. “Why are they on oxygen?” EMS response, “I don’t know he was having chest pain.” EKG shows STEMI! The last thing you…
Overdose and EKGs they start to all look the same…widened QRS, that thing in aVR…vfib (hopefully not). Here’s a highlight of key EKG findings associated with a few toxidromes: (1) Bupropion overdose (2) TCA overdose (3) Di…
Chest pain…everyone gets it…sometimes when a patient says they have chest pain I get chest pain. What’s the solution to this chest pain epidemic? Troponins! Well not so fast because they aren’t fast…especially…
Left Bundle Branch Blocks (LBBBs) are scary because they can be confused for MIs and MIs are scary…almost as scary as Y2K. Which takes us back to the 90s…the good days, good music, great hairstyles, and Sgarbossa! 20 years ago w…
What do all these EKGs have in common? They are all hyperkalemia! How hyperK+ are they? Turns out it is probably hard to say…there’s a Basic Rubric: P…
