Tag Archives: bundle branch block

58 year old male CC: Chest pain

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Here’s an interesting case sent in by a faithful reader who wishes to remain anonymous. EMS is called to the residence of a 58 year old male complaining of chest discomfort. On arrival the patient is found sitting on the edge of the bed. He is anxious but alert and oriented to person, place, time, […]

Identifying STEMI in the presence of LBBB – Sgarbossa's Criteria – Part I

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There has been a lot of discussion lately about identifying AMI in the presence of LBBB (see Dr. Bearemy’s “My Emergency Medicine Blog” here and a recent thread on the EKG Club). I’ve also been receiving a lot of emails offlist, so I think a full discussion is in order. In my recent post Who […]

Computerized interpretive statements and bundle branch blocks

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Here’s an ECG that I’ve used in my 12 lead class for many years. It’s usually good for a laugh! I show this ECG right after I teach students to identify LBBB on the 12 lead ECG. I explain that it was captured on an emergency call for a 80 year old male who was […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Dan August
“Bad heartburn” – 82 y.o. female without chest pain.
Correction S* and T wave.
2014-08-21 01:53:14
Dan August
“Bad heartburn” – 82 y.o. female without chest pain.
ST elevation in all leads is caused by early repolarization. That's why the Q and T are mashed together. Could be a stemi, but you can't tell with this going on.
2014-08-21 01:51:45
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
Very interesting discussion - I had not anticipated the degree to which giving/not giving nitro would be controversial! I had my own agenda in presenting this case, but I think it would be better to follow the interest of our readers. I'll add a few pearls about ACS, nitro, and inferior STEMIs in my discussion…
2014-08-21 00:14:19
Sassy
“Bad heartburn” – 82 y.o. female without chest pain.
Our local protocols prevent administration of GTN to RVI, Inferior STEMI with BP less than 160 systolic or HR less than 50bpm. As more than 50% of inferior MI's have RV involvement you walk a very fine line between preload and none. The HR could possibly indicate RCA occlusion so there's one side of your…
2014-08-20 22:23:14
Jonathan
“Bad heartburn” – 82 y.o. female without chest pain.
*Strongly consider withholding GTN and Morphine which could decrease venous return.
2014-08-20 21:22:02

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