Lead aVR is a commonly ignored lead and I have even heard of it referred to as the Rodney Dangerfield of ECG leads as it gets no respect. I have anecdotally heard many EM physicians activate the cath lab for STE in lead aVR and many cardiologists say that these are not STEMI patients. So […]
Background: The electrocardiogram (ECG) is one of the most useful diagnostic studies for identification of acute coronary syndrome (ACS) and acute myocardial infarction (AMI). The classic teaching is ST-segment elevation myocardial infarction (STEMI) is defined as symptoms consistent with acute coronary syndrome (ACS) + new ST-segment elevation at the J point in at least 2 […]
Background: Left Bundle Branch Block (LBBB) on the ECG makes accurate recognition of ST-Elevation Myocardial Infarction (STEMI) rather difficult. The 1996 and 2004 American College of Cardiology/American Heart Association (ACC/AHA) STEMI guidelines recommended immediate reperfusion therapy for patients with potentially ischemic symptoms and new, or presumed new, LBBB. In 2013, this recommendation was removed from […]
Background: As emergency providers we must be smarter than our ECG machines. Many times subtle findings on ECGs are not read by the machine, but we must be the experts at making the distinction between findings that require emergent treatment versus more benign etiologies. One specific set of diagnoses that can be very difficult to […]
A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.
According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation. She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest. Today she awoke with substernal chest pain that never resolved and continued in the emergency department. She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.
BP 127/89 HR 76 RR 20 O2 sat 100% on 2L NC Temp 99.3
Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
CTA B
2+ pulses in her extremities, no edema
ECG is shown (No prior ECG for comparison)…..
