NSTEMI https://www.ecgguru.com/taxonomy/term/365/all en Atrial fibrillation and Type 2 M.I. https://www.ecgguru.com/ecg/atrial-fibrillation-and-type-2-mi <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/atrial-fibrillation-and-type-2-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/12%20channel%20page%20one.jpg" width="1800" height="1151" alt="" /></a></div><div class="field-item odd"><a href="/ecg/atrial-fibrillation-and-type-2-mi"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/12%20channel%20page%202.jpg" width="1800" height="1116" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%; color: #00b050;">The Patient:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">     </span></span>This excellent teaching case was donated to the ECG Guru by our friend, Sebastian Garay (who is an ECG Guru himself).<span style="mso-spacerun: yes;">  </span>It was taken from a 33-year-old man who was complaining of chest pain and palpitations. He reported a similar episode about six months prior, but failed to follow up with cardiology. Was told by his medical care provider that he had atrial fib.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 14.0pt; line-height: 107%; color: #00b050;">The ECG:</span></strong><span style="color: #00b050;"><span style="mso-spacerun: yes;">      </span></span>We are able in this case to provide a 12-lead ECG with each lead recorded for the entire width of the paper. This has the advantage of producing twelve ten-second rhythm strips.<span style="mso-spacerun: yes;">  </span>Page one contains the limb leads, and page two shows us the precordial leads.</p><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;">The rhythm</strong> is atrial fibrillation, with a heart <strong style="mso-bidi-font-weight: normal;">rate</strong> of 133 bpm and an irregularly irregular rhythm. The <strong style="mso-bidi-font-weight: normal;">QRS axis</strong> is extreme left at about -75 degrees.<span style="mso-spacerun: yes;">  </span>This has caused Leads II, III, and aVF to be negatively deflected, and aVR and aVL to be positive. Lead I is biphasic, low voltage, and mostly positive, indicating that the axis travels almost perpendicular to Lead I, but slightly toward it.</p><p class="MsoNormal">The machine mistakenly gives us a reading for PR interval and P wave axis, even though there are no P waves.<span style="mso-spacerun: yes;">  </span>The QRS is on the wide side without being abnormal at .10 seconds (100 ms). The QTc is within normal limits, although it might be considered “borderline”, with 431-450 usually considered borderline.</p></div></div></div> Sat, 20 Jul 2019 19:41:02 +0000 Dawn 774 at https://www.ecgguru.com Acute M.I.: Occluded Stents in Left Obtuse Marginal Artery https://www.ecgguru.com/ecg/acute-mi-occluded-stents-left-obtuse-marginal-artery <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/acute-mi-occluded-stents-left-obtuse-marginal-artery"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/CAD107.jpg" width="1800" height="979" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG illustrates what some would call a non-ST-elevation M.I., but may also illustrate the limitations of a standard 12-Lead ECG. &nbsp;This female patient in her 60's presented to the Emergency Department with vague chest discomfort. &nbsp;She was cool and diaphoretic. &nbsp;She gave a history of having coronary artery stents placed in the past. &nbsp;On angiography in the cath lab, she was found to have two stents in her obtuse marginal artery which were occluded. &nbsp;Her case was lost to followup.</p><p>The ECG shows ST depression in anterior leads V2 through V6, as well as in the inferior leads, although very subtle. &nbsp;The inferior leads' ST segments are more horizontal than depressed, but flat and horizontal is not normal. &nbsp;She shows a bit of upward concavity or slight elevation in V1, Lead I, and aVL. &nbsp;These signs might be missed by someone looking only for ST ELEVATION. &nbsp;Additional left lateral and posterior leads were not done, and we have to wonder if she would have had some ST elevation in V7 or V8.</p><p>Her rhythm is very interesting too. &nbsp;Often, ischemic hearts produce abnormal rhythms, and it is not unexpected. &nbsp;The rate and the rhythm caused this patient no difficulties during her time in the ED. &nbsp;On first glance, her QRS complexes appear to be "grouped", as they would in a Wenckebach type block. &nbsp;On closer inspection, you will see two distinctly different P waves, and no non-conducted P waves. &nbsp;This appears to be a sinus rhythm with frequent PACs. &nbsp;The PRI is prolonged at .28 sec., which also is not unusual for M.I. patients.</p><p>We are very interested to hear what YOU think about this interesting ECG, including the rhythm. &nbsp;We are hoping to hear from people from all areas of cardiac care - what do you think are the main teaching points of this case?</p></div></div></div> Sun, 28 Jul 2013 21:02:54 +0000 Dawn 477 at https://www.ecgguru.com