Regular, steady, and fast at 170 (wide or narrow?), hypoxic, crackles in lungs, B-lines, unconscious
A 60-something who lives in a nursing home was found unconscious and hypoxic. EMS was called and their monitor showed an “SVT” at…
What do you think about this Left Bundle Branch Block?
I was reading through a stack of ECGs and saw this one: The Veritas computer algorithm called it Left Bundle Branch Block without ischemia.…
Is this terminal QRS distortion? Is there LVH?
This ECG of a patient was sent to me with the question, “Just LVH, no?” What do you think? First, is there Terminal QRS…
What is this tachycardia that alternates from wide to narrow to wide?
This is 50-something who presented after a seizure and was unconscious and tachycardic: There is a wide complex, followed by a narrow complex,…
A 40 yo with Chest pain. Only ECG abnormality is minimal ST depression in I and aVL (computer interpretation: normal)
A former resident sent this. He asked: “Hey Steve, Wanted to get your thoughts on this EKG:” What do you think? The computer…
A Young Man with Sharp Chest pain
Suppose this patient had chest pain. What would you diagnose? What is the diagnosis? OK. I lied, just so you could assess your…
Tachycardia, fever to 105, and ischemic ST Elevation — a Bridge too Far
A near 60 year old male called 911 for increasingly severe fever and SOB. A prehospital ECG was recorded (not shown and not seen by me)…
Following Criteria Exactly, even the Modified Sgarbossa Criteria, Can Be Deadly
This was sent by a reader: Dear Dr Smith, I am an EM resident and a rather new reader of your blog. I am writing to ask for your opinion…
What happens when a patient with LAD OMI does not go immediately to the cath lab?
This patient was extremely elderly, and although the diagnosis was recognized, she did not go to the cath lab for reasons related to age and…
Epigastric pain radiating to the chest for 18 hours. ECG makes the Dx. Troponin makes the Dx. CT makes the Dx!
I was shown this ECG with no other information: What do you think? Hint: try to see through the artifact! I answered immediately: “High…