It’s a hot summer night in the suburbs, most of which you’ve spent on standby for a local baseball game. After clearing up you’re put on a chest pain call a few blocks from your quarters. The local volunteer fire department has a squad on scene which is advising you to, “continue on emergency.” Upon […]

This is the discussion for 63 year old male: Chest Pain. Many of you thought the original 12 leads showed Wellens' Syndrome.  Lets review some key points about the T wave inversions of Wellens' for a moment: They occur when an occluded artery is reperfused, spontaneously or otherwise They are always recorded during a pain […]

This is the conclusion to 54 year old female CC: BLS intercept. I did not expect to get so many comments! Great discussion on many points. It even afforded an opportunity to review atrioventricular blocks. Going back to the case let’s look at the initial 12-Lead ECG. As many readers noted, there is a lot […]

This is the conclusion to 77 year old female CC: Chest pain. Thanks for all the great comments! You guys never disappoint. Let's take another look at the initial 12-lead ECG. Here is one of the serial 12-lead ECGs taken about 15 minutes later. It's subtle but there are clear changes in QRS, ST and […]

This is the conclusion to 71 year old male CC: Chest pain. Thanks for all the great comments! Let’s take another look at the 12-lead ECG. This 12-lead ECG shows acute anterior ST-elevation myocardial infarction. Significant ST-elevation is present in leads V2-V5, I and aVL with reciprocal ST-depression in leads III and aVF. A “STEMI […]

This is a real challenge because it meets the voltage criteria for left ventricular hypertrophy in the limb leads.

Here is the conclusion to 73 year old female CC: Chest pain. I’m sorry the conclusion to this case took so long. Due to a clerical error I received a duplicate case. Let’s take another look at the 12-lead ECG. The patient was emergently cathed and a partially occlusive thrombotic lesion was identified in the […]

Here is the conclusion to 43 year old female CC: Chest pain. Let’s take another look at her 12-lead ECG. This patient experienced cardiac arrest on arrival in the emergency department. She was defibrillated while still on the EMS gurney, stabilized, and then transferred to the cardiac catheterization lab. Here we see a proximal occlusion […]

An 81 year male presents to the fire station to have his blood pressure checked. He tells the paramedics he had just finished a round of golf and was sitting in the clubhouse when he felt “cold and shaky.” He states that he went out to his car, rolled up the windows in the warm […]

Here’s the final update on the 74 year old male CC: Chest pain. Let’s take another look at the 12-lead ECG. The first update to the case is here: Update to 74 year old male CC: Chest pain In the update I showed the right precordial leads “flipped” to help see the STEMI. Here are […]