ECG Mixtape: Vol. 1

Welcome to the start of a new series here at EMS 12-Lead. With the ECG Mixtapes we’ll compile some of the week’s best ECG’s from around the world of social media and #FOAMed. As High Fidelity taught us, “The making of a great compilation tape, like breaking up, is hard to do and takes ages longer than it may seem.” Please dig deeper into the cases that interest you. Pick of the Week This week’s top pick comes from Mohd Faried over at the EKG Club on Facebook. Click the image for a link to the original post on Facebook. The patient, a 58 year old female, presented with chest pain x 1 hour with diaphoresis and signs of heart failure. This ECG shows sinus tachycardia, a (presumed) new RBBB, severe ST-depression in the inferior leads, and towering ST-elevation in aVR—which add up to quite a poor prognosis. It is important not to mistake the profound ST-changes in the limb leads for an extremely wide QRS (> 240 ms); the QRS in this tracing is really about 170 ms. Now, despite common teaching, most cases of diffuse ST-depression with ST-elevation in aVR are not caused by acute occlusion of the left main coronary and often do not require immediate catheterization (for a lot more on this topic check out this post). the tracing above is unique for two reasons: The magnitudes of the ST-deviations in the limb leads are huge (though this can be seen in patients without obstructive coronary artery disease too). There are almost no ST-deviations i...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ECG Mixtape Vince DiGiulio Source Type: research