ECG Mixtape: Vol. 2

Welcome to the second installment in our ECG Mixtape series! It looks like this will be an irregular publication while we streamline our process of picking cases and getting permission to reproduce them. Enjoy! Pick of the Week This weeks top pick comes from cardiologist Dr. Gianni Manzo in São Paulo, Brazil, who shared this case on the Figure 1 app [note: the app and site require free registration to view cases]. A 78 year old male presented with a chief complaint of “oppressive” chest pain. The patient’s past cardiac history was significant for coronary artery bypass graft (CABG) surgery and pacemaker. The following ECG was obtained on arrival. It shows an AV-sequential paced rhythm at approximately 70 bpm (probably a DDDR pacemaker). Most folks would just end their interpretation there (and the machine certainly will), but there’s a lot more to see on this tracing… like an infero-posterior STEMI! Somehow the myth persists that you can’t identify ischemia in the setting of a paced rhythm. I don’t know it survives—I’ve got texts that Marriott wrote decades ago demonstrating STEMI’s with pacemakers—yet at least once a week I hear someone say, “He’s got a pacemaker; we can’t tell if there’s ischemia.” The key is Sgarbossa’s criteria (and Smith’s modification), used to identify ischemia in the setting of left bundle branch block (LBBB); they can also be applied to paced rhyth...
Source: EMS 12-Lead - Category: Cardiology Authors: Tags: ECG Mixtape Vince DiGiulio Source Type: research