Tag Archives: benign early repolarization

The early repolarization experiment

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Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

50 year old male CC: Chest Pressure – Discussion

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This is the discussion for 50 year old male CC: Chest Pressure. We could not have been happier at the number of insightful comments we received on this case! Many of you caught on to our purpose for this case as we could not have picked a better borderline example! When we last left our […]

53 year old male with a suspicious ECG – Conclusion

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This one was really challenging because we all know that reciprocal changes are strongly supportive of acute STEMI.

Is this a mimic or the real thing? – Discussion

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This is the follow-up discussion to: Tweet about ECG leads to mystery – is this a mimic or the real thing? Let’s take another look at the 12-lead ECG. This is a very suspicious ECG and must be considered acute inferior STEMI until proven otherwise. This was my initial gut feeling about this ECG and […]

Early Bird Gets the Worm – Conclusion

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The conclusion to the November 2010 EMS 12-Lead column Early Bird Gets the Worm is now posted at EMS1.com. Early Bird Gets the Worm: Patient Follow-Up You can become a fan of EMS1.com on Facebook by clicking HERE.

63 year old male CC: Syncope – Conclusion

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Here is the conlcusion to 63 year old male CC: Syncope. First, let’s take another look at the 12-lead ECG. This 12-lead ECG shows poor data quality. This is a problem because the ECG is abnormal and suspicious for acute anterior STEMI. We need to consider whether or not this could be benign early repolarization […]

47 year old female CC: Chest pain – Discussion

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Thanks for all the comments! I’m not allowed to blog while I’m on duty (the policy has nothing to do with me personally) so if it seems like I’m not responding, I’m probably just at work. The paramedic who submitted this case has requested the follow-up information from his supervisor, but unfortunately she’s out-of-town for […]

23 year old male CC: Chest Pain

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Here’s a fascinating case submitted by Geoff Dayne. EMS is called to a VA clinic for a 23 year old male who came in to get checked into the system. Somewhere in the exchange, he mentioned that he had been experiencing chest pain off & on for just over a month. Onset: Today’s pain came […]

41 year old male CC: Chest pain

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41 year old male complaining of chest discomfort. The patient has had similar episodes before (after exertion), but in the past it always cleared up after use of an asthma inhaler. EMS finds the patient sitting in a chair. He had just taken a shower, with no relief of the chest discomfort. He describes the […]

The problem of ST segment elevation

The criterion seems quite simple. In the absence of contraindications, reperfusion therapy should be administered to patients with symptom onset within the prior 12 hours and ST elevation greater than 0.1 mV (1 mm) in at least 2 contiguous precordial leads or at least 2 adjacent limb leads, or new or presumably new LBBB on […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Nick
100 yof CC: Rib pain and intermittent spasms
Can't be a potassium imbalance. The TW's wouldn't change and then change back. If it was coronary spasm, I would expect some ST segment elevation. The TW'S are also not hyperacute (peaked). Does she wear some sort of electronic stimulator?
2014-11-19 01:05:43
Anterior T wave inversions and PE. | EMS 12 Lead
Not just S1Q3T3: Look at the other 10 leads!
[…] Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: […]
2014-11-18 18:33:47
Christine
100 yof CC: Rib pain and intermittent spasms
I believe this may be coronary artery vasospasm.
2014-11-18 11:02:45
Ian Fudge
What it Looks Like: Cardiac Arrest
this is really interesting because something similar happened to a patient as I sat them up in bed after delivering them to a community hospital in fact I even turned to his son and said "does dad suffer with epilepsy?" And then turned back and realised he wasn't breathing
2014-11-18 07:59:13
Dustin
100 yof CC: Rib pain and intermittent spasms
External interference? Something like a bladder stimulator or spinal stimulator.
2014-11-18 00:32:54

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