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Post by pbruss on Jul 11, 2015 14:03:15 GMT -5
48 yo male, smokes but other wise healthy, takes no meds, no hx of cad in him or his family. was at work got lightheaded with some left sided cp with SOB. hos wife took his BP and it was "high" so they came in. in the ER mildly hypertensive but other VS normal. says hig light headedness is better but not gone. sob is gone, left side cp still come and goes, is better but not gone. he describes the pain and achey and dull, not reproducable, not worse with deep breath or movement. attached is his old ecg and the ecg in the ER. what do you think? Attachments:
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Post by kemple on Jul 11, 2015 15:27:13 GMT -5
NM I saw this case, won't spoil the answer.
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48 male CP
Jul 11, 2015 19:59:29 GMT -5
via mobile
Post by DD on Jul 11, 2015 19:59:29 GMT -5
Looks brugadaish.
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Post by Bjs04f on Jul 11, 2015 20:56:19 GMT -5
if new one is second seing R heart strain with incomplete RBBB and S1Q3T3 in I-III. With story he could be a PE
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Post by DD on Jul 12, 2015 0:42:38 GMT -5
if new one is second seing R heart strain with incomplete RBBB and S1Q3T3 in I-III. With story he could be a PE also true |
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Post by kemple on Jul 12, 2015 10:07:25 GMT -5
Well Brandon you had the idea I had when he first showed me the EKG, there is a subtle finding there.
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Post by jpollock on Jul 12, 2015 13:50:04 GMT -5
Wellen's?
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Post by mwiepking on Jul 12, 2015 15:35:22 GMT -5
I'd go with PE as well, echoing Brandon with the RBBB and S1Q3T3. Is there something to make of V4-5? It looks abnormal to me. I've seen that notching in bifascicular blocks but doesn't seem like this EKG has the rest of the features of a LAFB.
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Post by kemple on Jul 12, 2015 16:06:53 GMT -5
Pollock got it, subtle but had 100% LAD occlusion.
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Post by pbruss on Jul 12, 2015 16:09:23 GMT -5
should have knoe V's trained doc would get it. but the first thing i thought was PE but a closer look was concerned for wellins.
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Post by jpollock on Jul 13, 2015 8:55:06 GMT -5
PE was actually my first thought as well. Not sure I would have got it if it had been in a pile on my keyboard when I came back to my workstation.
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Post by tyson on Jul 13, 2015 13:31:58 GMT -5
i can safely say i would have missed that in acute phase.
would have admitted for ACS r/o especially w/ extensive new EKG changes.
but would have missed wellens.
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Post by DD on Jul 13, 2015 17:50:31 GMT -5
Odd that it's present during an acute attack no?
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Post by pbruss on Jul 14, 2015 8:09:57 GMT -5
indubitably odd. i was willing to bet money was PE at the first sight of the ekg and the history. i was lucky the cardiologist took him he said "i trust you pat", i was more shocked then when i found out a chick i was dating was not a chick.
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Post by jpollock on Jul 14, 2015 10:16:07 GMT -5
yea typically wellens is noticed after the pain/attack resolves.
Bruss: now you could marry that 'chick' in any state
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