Cardiology
EKG Nuggets: Spice Up Your Learning!
Welcome to our EKG Nuggets series where we spice up your learning with some electrifying insights presented by a Cardiologist!
Since Nashville holds the crown for the world's hot chicken capital, we're borrowing its flavor scale to rate the appropriateness/difficulty of these nuggets for different audiences:
- Mild (for the med students and interns)
- Medium (senior residents, come on down!)
- Spicy (calling all cardiology fellows and junior cardiologists!)
- Extra Spicy (senior cardiologists and rhythm specialists, let's turn up the heat!)
In each episode, get ready for a short video (less than 10 minutes) where we'll doodle and scribble directly on the EKG.
Hope you're ready for this spicy learning journey! 🌶️🔥
I would like to share with you this case I saw in Nashville a couple of days ago..
A 47-year-old Hispanic lady, presented to the Emergency department (ED) with chest pain while climbing the stairs. The pain lasted for 45 min before arrival to ED.
Her presenting EKG is shown here.
What is the interpretation of the EKG, and what we do next?
I want to share this "routine" case we see everyday, but it has a little twist that we don't see very often. No tricks here!!
This is a 41-y-o Hispanic male, presented with lingering CP x 12 hrs. Exam negative.
Presenting EKG below:
Troponins below:
Did well overnight. No recurrent CP.
What's next: Stress or Cath?
84 Year old lady presented to the hospital with recurrent stroke. Patient was in other hospital 8 days before because of stroke. The brain CT showed embolic stroke picture. The Echo report from the prior stroke was normal. This is her echo this admission. What are the differential diagnosis for this?
This is a straightforward EKG that everyone should know. We saw this patient a week ago.
He is 56-y-o-Hispanic man in ER with SOB.
What is the interpretation? What is next?
I need your help and guidance about this current patient I have.
This is a 55-year-old male with history of diabetes and hyperlipidemia. He presented to another hospital in June with anterior wall STEMI (EKG shown).
He underwent PCI to LAD, unfortunately was a tough case with suboptimal result. He also has severe disease as shown in the attached angios.
He then switch care to us and we are following him for the last 2 months. He is completely asymptomatic and very functional and does active labor work with no restrictions. His echocardiogram showed an ejection fraction of 35-40% roughly.
his cardiac MRI shows nonviable anterior wall in the middle and apical segments. There was also some inferolateral infarct. There was a comment about mild inferior hypokinesis. Ejection fraction by MRI is 39%.
His currently on reasonable medical therapy including dual antiplatelet therapy, statin, carvedilol, Ace inhibitors. Just switched to Entresto a couple of days ago. His blood pressure soft and pushing medicine further may be a challenge.
Questions:
-Would he benefit from PCI to RCA ( can he fit COMPLETE trial picture)?
-How about ICD?
Hs-Troponin (hs-cTn) assays were recently (Jan - 2017) approved by FDA and now become increasingly used in the U.S. to replace conventional Troponin (c-cTn).
I am curious about people's experience in the transition from c-cTn to hs-cTn. Please share your experience? how did it go?
Dear colleagues/friends,
I need your help with a case that we saw last week. I am not sure we know exactly what is going on with her. I am wondering if you see a similar case before, or how would you manage her if she is yours. Will tell you later what we decided to do.
Appreciate your help!
tnx
History:
66-year-old female with PMH significant for hypertension, type 2 diabetes mellitus, and chronic pain (followed at pain clinic) presents to ED for evaluation of chest pain.
Patient reports intermittent sharp, achy chest pain beginning 3 days ago. Mostly located above and around left breast with some radiation into left arm. She also reports mid upper back pain at times. Exacerbated with deep breaths but denies alleviating factors.
She denies prior hx of DVT/PE, recent prolonged travel, recent surgeries. Denies fever, chills, palpitations.
ED workup mostly unremarkable but D-Dimer is elevated at 1580. Chest x-ray negative for acute process. CT a chest showed filling defect pulmonic valve. Questionable for focal thrombus, potentially infected vegetation, or soft tissue mass/neoplasm.
Attached images from CT (with contrast) and TEE.
