Tag Archives: concordant ST-elevation

64 year old female CC: Trouble Breathing – Conclusion

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Lots of great comments and it was good to see the depth of discussion on the appropriate treatment and transport for this patient! This is the conclusion to 64 year old female CC: Trouble Breathing. When we left off our crew was attending to an elderly female patient in respiratory extremis. Pulmonary edema was present […]

88 year old female CC: Chest pain – Conclusion

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This is the conclusion to 88 year old male CC: Chest pain. Let's take another look at the 12-lead ECG. This ECG shows acute STEMI in the presence of left bundle branch block. It's also an excellent example of the value of using "excessive discordance" to identify acute STEMI in the presence of left bundle […]

58 year old female CC: Chest pain – Conclusion

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Here’s the conclusion to the 58 year old female with chest pain and left bundle branch block. To refresh your memory here is the 12-lead ECG. And for those of you who requested lead V4R. This ECG meets all 3 of Sgarbossa’s criteria to identify acute STEMI in the presence of left bundle branch block. Keep […]

58 year old female CC: Chest pain

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Here’s another case study from an international reader who wishes to remain anonymous. Presenting Complaint – Chest Pain History of Present Complaint – 58 year old female, nil cardiac history, mild smoker, social drinker and overweight. Complaining of acute central chest pain @ rest. Awoken by pain. On Arrival – Sat upright on settee (Editor’s […]

Sgarbossa's Criteria – New Graphic

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Here is a graphic I created to help explain Sgarbossa’s criteria for identifying acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) or paced rhythm. In a previous article I showed this graphic which was created using PowerPoint. Here is a similar graphic I created this morning by cropping actual ECGs […]

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

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In Part I, we discussed Sgarbossa’s Criteria for identifying AMI in the presence of LBBB. We also talked about the “rule of appropriate T wave discordance” for bundle branch blocks and other forms of abnormal depolarization (like ventricular rhythms or paced rhythms). You will recall that I drew a distinction between a QRS complex’s main […]

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 […]

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Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Sharon Sinclair
The 12 Leads of Christmas: V3
As a technician, I absolutely love how comprehensive these posts are. Although I do not have the advanced knowledge or understanding of a licensed provider, I try to absorb as much as I can from posts like these. Maybe one day I will muster the courage to transition to a more advanced position in cardiac…
2015-02-28 20:40:17
A visit to Johns Hopkins #EMSToday2015 | EMS 12 Lead
Episode #11 – Are we harming patients with oxygen?
[…] might remember Mike from one of our most popular EMS 12-Lead podcasts Episode #11: Are we harming patients with oxygen? We finished up the night with food and adult beverages in the […]
2015-02-25 14:33:03
Rollo
The Trouble with Sinus Tachycardia
Had a pt today with a rate @ and around 160, it was indeed sinus tachycardia. The tachycardia was secondary to a stimulant which caused over stimulation of sympathetic nervous system ie sympathomimetic O.D. The treatment was fluid and a benzo. Problem solved.
2015-02-25 00:14:18
Jeff Reader
The 12 Leads of Christmas: V3
When looking at how the heart sits in the chest and how things are named remember they were probabily named during autopsys when the cadaver was on its back.
2015-02-24 16:55:04
darren
58 year old female CC: Chest pain
I would be inclined to ignore QTC as rate is above 100 and unreliable to interpret less than 50 or more than 80. ST segments are interesting as is the history. PE was my first impression AnterioSeptal MI second impression but I'm inclined to consider LV Aneurysm as third Impression as no reciprocal changes?
2015-02-24 04:01:24

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