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4
EKG #2
7
EKG #3
I II III
MCL-1
EKG #4
13
EKG #5
1 2 3
LBBB
RBBB
EKG #7
21
EKG #8
19 year old
male with
complaints
of
palpitations
19 year old
male with
complaints
of dizziness
and
palpitations
27
EKG #10
This patient is a 50 year old man who presented to the ED with chest tightness
and is noted to be markedly hypotensive on exam. What is your therapy
for BP restoration? A. Dopamine B. IVF bolus C. Balloon pump
EKG #10
This patient is a 50 year old man who presented to the ED with chest tightness
and is noted to be markedly hypotensive on exam. What is your therapy
for BP restoration? A. Dopamine B. IVF bolus C. Balloon pump
What about the right side?
RV infarcts
Occur in conjunction with inferior MIs
Move V4 to the
right side same
location
5th intercostal
space anterior
axillary
29
Acute MI with RV involvement
30
Acute MI with RV involvement
IVF to increase filling pressures
Inotropes to follow IVF loading
RV - VAD
31
EKG #11
This patient is 40 year old woman with pleuritic chest pain and
breathlessness. What is the diagnostic test of choice?
a. Echo
b. CTA
c. CXR
EKG #11
This patient is 40 year old woman with pleuritic chest pain and
breathlessness. What is the diagnostic test of choice?
a. Echo
b. CTA
c. CXR
S1Q3T3 pattern is only second to D-dimer
EKG #12
1. J-point “notching”
2. Concave-up ST segment
(smiley face)
3. ST segment elevation
from baseline in V2-V5,
typically <3mm
4. Large, symmetrically
concordant T-waves in
leads with STE
42
Classic findings
1. J-point “notching”
2. Concave-up ST segment
(smiley face)
3. ST segment elevation
from baseline in V2-V5,
typically <3mm
4. Large, symmetrically
concordant T-waves in
leads with STE
43
Can we tease it out?
The degree of ST segment elevation is thought to be
indirectly proportional to the degree of sympathetic tone
Ifyou truly want to test your patient, get their heart rate up
and look at the ST segment
44
HR 64 HR 83
The ST segment is NOT fixed in pts w/ BER and changes from EKG
to EKG and with the degree of sympathetic strain