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)…
The delay between OMI and STEMI claims yet another patient’s anterior wall
Written by Pendell Meyers with edits by Steve Smith An elderly woman with HTN presented with L sided chest pain, intermittent over the past…
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…
An elderly woman transferred to you for chest pain, shortness of breath, and positive troponin – does she need the cath lab now?
Written by Alex Bracey, with edits by Smith and Meyers A female in her 70s presented to the ED at sign out while working in our acute…
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…
Three EKGs shown to me – which if any need emergent reperfusion?
Written by Pendell Meyers We commonly get feedback from readers who are skeptical that we can pick out the subtle NSTEMI occlusions from…
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…
An 80 year old man in VF arrest
An elderly man suffered out of hospital cardiac arrest. He was found in V Fib by EMS. He was shocked out of VF multiple times and arrived in…
A Pathognomonic ECG. What is it?
This patient presented with weakness, decreased urine output, and vomiting: What is the ECG diagnosis? There is a very long QT (computer says…
IVCD, Saddleback STE in III, with reciprocal STD in aVL: Is it pseudoOMI or OMI? Echo with Speckle Tracking gives the answer.
A 77 y.o. woman with a history of hypertension and congestive heart failure presented for acute onset chest pain and shortness of breath. She…