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

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Interesting/Unusual ECGs

Gabriel Gregoratos, MD

#7. 58-year old male MD seen in ED with atypical chest pain for 45 minutes; TnI <0.3

#8. Same patient 15 minutes later

#13. 60-year old diabetic man reports vague sub-sternal discomfort on 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)

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#14. Same patient: ECG after 2 min. on treadmill on a modified Bruce protocol. Patient reports mild chest

• discomfort. ECG time 10 PM

#15. Same patient: Repeat ECG in ED after termination of the

treadmill test. Patient symptom-free. Time 1030 PM

#16. Same patient: ECG at 6 AM next morning

#17. BB player with severe left chest pain and dyspnea

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#19. 38-year old man with anterior chest pain, worse on inspiration.

#22. 66-year old woman comes to ED at 6 AM with chest pain, dyspnea, palpitations overnight. Had normal ECG 6 months ago.

Same patient. PA chest X-Ray

#23. 44-year old healthy MD who collapsed with chest pain and dyspnea while jogging.

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#24. Same patient after an intervention #25. 72-year old woman transferred to ED from another treatment facility with dyspnea and CP

#26. 72-year old woman with known angina. Comes to ED because of a prolonged episode of CP. Normal Tn I.

#27. Same patient 3 months later; comes to ED with severe substernal CP for 1 hour

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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