1 - mattu, amal ecgs
DESCRIPTION
ECGSTRANSCRIPT
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High Risk ECGs
Amal Mattu, MD Professor and Vice Chair
Department of Emergency Medicine University of Maryland School of Medicine
Baltimore, Maryland [email protected]
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A Few Points To Start…
• Workshop – Questions? à [email protected]
• Writing • Handout/PDF • “Gold standard” à Marriott, Chou • www.ekg.umem.org à EKG cases of
the week • Advanced video course on emedhome,
books à ACEP bookstore
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Why is this important?
• ACS is high-risk but high payoff! – Very good outcome vs. very bad outcome
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#1: 38 yo man with sharp chest pain and dyspnea
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STEMI or Acute Pericarditis?
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ECGs and Pericarditis
1. Factors that rule-in STEMI – STD except in V1 or aVR
• (STD in V1 or aVR is allowed in AP) – STE in III > II – Horizontal or convex upwards STE – Q-waves that you know are new
2. Factors that suggest AP – Friction rub – PR depression in multiple leads
• (Only reliably seen in viral AP, transient)
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ECGs and Pericarditis
When in doubt, get serial ECGs!
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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STEMI or AP?
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Causes of STE…
When in doubt, get serial ECGs!
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STEMI or AP?
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STEMI or AP?
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STEMI or Acute Pericarditis?
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STEMI
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STEMI or AP?
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Acute pericarditis…?
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Acute pericarditis…?
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Acute pericarditis…?
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Diffuse ischemia
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#2: 55 yo woman with SOB, chest heaviness
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55 yo woman with SOB, chest heaviness
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55 yo woman with SOB, chest heaviness
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Large Pericardial Effusion (LV + tachy)
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Pericardial Effusions
• Low voltage + tachycardia = pericardial effusion until proven otherwise
• When in doubt about the ECG baseline, use the T-P segment!
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#3: 48 yo man with chest pain and dyspnea
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Pulmonary Embolism
• New T-wave inversions are very common in cases of large PEs
• Especially common in anteroseptal leads • Marriott and other others:
– Simultaneous TWIs in anteroseptal + inferior leads is HIGHLY specific for acute pulmonary hypertension (= PE)
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Pulmonary Embolism
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PE Simulating ACS — Case 2
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Baseline ECG
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PE Simulating ACS — Case 3
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Baseline ECG
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PE Simulating ACS — Case 4
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Baseline ECG
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PE Simulating ACS — Case 5
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PE Simulating ACS — Case 5
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#4: 62 yo woman presents unconscious
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#4: Intracranial Hemorrhage
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Intracranial Hemorrhage
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Intracranial Hemorrhage
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Intracranial Hemorrhage
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Previous ECG
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Intracranial Hemorrhage
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Intracranial Hemorrhage
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Intracranial Hemorrhage
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#5: 49 yo man with vomiting and diarrhea for 3 days
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#5: Severe Hypokalemia
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Severe Hypokalemia
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Severe Hypokalemia
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Severe hypokalemia
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Digoxin Toxicity With Hypokalemia
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Remember…
• Just because electrocardiography is a basic skill in EM doesn’t mean that our skills should be basic.
• YOU must be the experts in electrocardiography!