Left anterior fascicular block (LAFB)

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A reader by the name of Jesse contacted me and wrote: I have a question. I’m trying to learn more about fasicular and hemi blocks. I was curious if you have posted, or intend to post, any information regarding these. I understand this is all done on your free time, so no rush at all. […]

12-Lead ECG Case Studies

My department is starting a 12-lead ECG “case of the month” as part of our continuing education. Each month, I will select an ECG that was transmitted from the field and resulted in a cath lab activation. Whenever possible, I will include the “before” and “after” angiograms so that the paramedics receive feedback about the […]

False positive cardiac cath lab activations – PowerPoint

Here’s an interesting PowerPoint presentation that corresponds to a previous post. False Positive Cath Lab Activatin C R T Version from momiamd I found slide 14 to be particularly interesting. This is a topic that doesn’t get enough attention. Often the quarterly STEMI meetings go over the success stories but not the failures. It’s often […]

78 yom CC: "Chest heaviness"

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Here’s an interesting case submitted by Alex Kroeze. He is currently taking a sabbatical from blogging but was kind enough to share this interesting case with me. Here is the story in Alex’s own words. 78 year old male with a history of MI with cardiac arrest around 1975 as well as diabetes (metformin) and […]

Dr. Sanjay Gupta's "Cheating Death" series

Embedded video from CNN VideoEmbedded video from CNN VideoEmbedded video from CNN Video

Syncope, Chest Pain, and LAD Occlusion – Part 2

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This is the conclusion to Syncope, Chest Pain, and LAD Occlusion – Part 1. Let’s take another look at the 12-lead ECG. There is a regular rhythm at a rate of 60 (using the large block method there are 5 blocks between R-waves). The QRS complex is narrow at 86 ms. There are P-waves in […]

Narrow complex tachycardias – Part III

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Documenting the heart’s response to adenosine Let’s look at some different cases where adenosine was used. Rather than give you all the details about the age, gender, chief complaint, and vital signs, I’m just going to show you the rhythm strips. Right now I’m only concerned with how the heart behaves during the administration adenosine. […]

43 year old female CC: "Indigestion-like" chest discomfort

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Thanks to Jim Tarro for the following case study 43 year old female presents to EMS with “indigestion-like” chest discomfort. She states that it “feels like a previous heart attack.” Onset: Several hours ago Provoke: Antacids make the pain feel better Quality: “Indigestion-like” chest pain Radiate: The pain does not radiate Severity: She gives the […]

Heart attack study looking at whether giving clot-buster in ambulance is best

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Photo credit: The Canadian Press A recent story from the Canadian Press talks about the international STREAM study (Strategic Reperfusion Early After Myocardial Infarction). “It’s widely recognized that the faster you treat a heart attack, the better the outcomes,” says Dr. Warren Cantor, a cardiologist at Southlake. “You can preserve heart muscle and increase a […]

Syncope, Chest Pain, and LAD Occlusion – Part 1

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EMS is called to a community event for a patient who experienced a syncopal episode. On arrival, the patient is found slumped back in a chair with a cold, moist towel on his head. His eyes are closed, he is groaning, and appears acutely ill with pale and diaphoretic skin. Bystanders say that he passed […]

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