Interesting/Unusual ECGs Gabriel Gregoratos, MD #13. 60-year old - PDF document

12/16/16 #7. 58-year old male MD seen in ED with atypical chest pain for 45 minutes; TnI <0.3 Interesting/Unusual ECGs Gabriel Gregoratos, MD #13. 60-year old diabetic man reports vague sub-sternal discomfort on #8. Same patient 15 minutes later and off past 24 hours comes to ED at 8 PM (ECG 1 of 4). He is now pain- free. Tn I is <0.3 (negative) 1

12/16/16 #14. Same patient: ECG after 2 min. on treadmill on a #15 . Same patient: Repeat ECG in ED after termination of the modified Bruce protocol. Patient reports mild chest treadmill test. Patient symptom-free. Time 1030 PM discomfort. ECG time 10 PM #16. Same patient: ECG at 6 AM next morning #17. BB player with severe left chest pain and dyspnea 2

12/16/16 #19. 38-year old man with anterior chest #22. 66-year old woman comes to ED at 6 AM with chest pain, dyspnea, palpitations overnight. Had normal ECG 6 pain, worse on inspiration. months ago. #23. 44-year old healthy MD who collapsed with Same patient. PA chest X-Ray chest pain and dyspnea while jogging . 3

12/16/16 #25. 72-year old woman transferred to ED from #24. Same patient after an intervention another treatment facility with dyspnea and CP #26. 72-year old woman with known angina. Comes to ED #27. Same patient 3 months later; comes to ED with because of a prolonged episode of CP. Normal Tn I. severe substernal CP for 1 hour 4

12/16/16 Sgarbossa’s ECG Criteria for STEMI in the presence of LBBB (from GUSTO-1) • ST elevation ≥ 5mm, if QRS is negative - 2 points • ST elevation ≥ 1 mm, if QRS is positive - 3 points • ST depression ≥ 1 mm in V1, V2, V3 - 5 points • Meta-analysis of 2100 patients* ♥ Score ≥ 3: useful in diagnosis of AMI ♥ Score = 2: inadequate to diagnose AMI ♥ Score = 0: cannot rule out AMI * Tabas et al. Ann Emerg Med 2008;52:329 5