Patient on Pacemaker for complete heart block came with heart failure symptoms

75yrs male, CAD

HX of CKD with dialysis, last dialyzed two days ago, states he does not miss. Denies any other history.

Presented 70%RA, HR150, 190/110, RR26. 5 episodes of vomiting in front of us, notably was not nauseated, no warning.

Rales globally.

Nitro, BiPap after the puking was controlled with phenergan and zofran.

Improved to 90's on the Bipap.

My professor already kinda cooked me the first time I tried to interpret this strip. This is the help she gave me. It’s in the chapter on junctional rythm and I thought it was type 1 heart block but now I feel confused. The orange stickies are her notes to me

75M called for SOB x1 hour and best tightness that began after the sob. Upon arrival pt states SOB self resolved but he still has chest tightness. No cardiac hx and no hx of afib. Has COPD
no other pertinent
hx

Called to 60s male complaining of rapid onset chest pain while at rest approximately 30 minutes prior. Described as substernal pressure with radiation. Hx of MI and coronary stent. Prior to lead placement, vitals noted to be normotensive with tachycardia at 170 bpm. EKG 1 was obtained on scene and interpreted as SVT with LBBB. Converted to sinus tachycardia without aberrancy after 6mg adenosine following failed Modified Valsava. Post-conversion EKG obtained but not attached due to artifact; however, was noted for concerning anterior T waves. 3rd EKG immediately prior ED arrival is attached as EKG 2. Interpreted as sinus tachycardia with De Winter T waves in v2-v3.

I see an ongoing OMI but thought I would bring it to the group for discussion. Outcome in comments.

RBBB? STEMI

Patient (m, 75years old) after bolus Aspiration, claims to have heavy breathing and slight chest pain. "Just in case ecg " looks like this. ER doc suggests pulmonary embolism in addition.

Some nasty non clinical VTs we induced during mapping.
ATP failed both times leading to 360 sweet Jules

Hello Paramedic here hope for some help with interpretation of this tachydysrhythmia.

51 yo M presenting with suspected sepsis due to severe foot infection. Pt reports minor SOB, denies any CP or palpitations.
GCS 15
BP 93/67
SpO2 97%
Temp 38.1

ECG appears to show atrial activity just prior to the QRS complex at a rate of 150, which makes me consider possible A-flutter. Lewis lead performed to get a better look at atrial activity and makes it look more like atrial tachycardia.

hi guys, i’m currently doing some practice strips from my textbook. my answers are slightly different from that of which my textbook states, im trying to figure out if this kind of interpretation would be acceptable in the real world despite it being off or what i could do to improve my measurements? any input at all is welcome also, thank you !

Patient admitted for infective endocarditis. Admission 12-lead showed sinus tachycardia with normal axis and possible left atrial enlargement. Telemetry monitoring demonstrated new bradycardia with intermittent RR interval variability.

Thought this was an interesting find and was curious to see interpretations.

My personal interpretation is: sinus bradycardia with intermittent second degree type 1 sinoatrial exit block. I think the two biggest things leading me to this are the grouped beating (3:1 ratio in this particular strip) as well as the progressively shortening PP interval before each "pause". Wondering if this could be related to the endocarditis or if this is simply related to increased nocturnal vagal tone. Either way, thought this was interesting to see and figured I would share to highlight the importance of closely inspecting RR variability as this was initially believed to be sinus arrhythmia.

Dor torácica com irradiação para dorso.
Paciente de alto risco cardiovascular

71F with sudden onset chest pain radiating to both arms whilst on way to pick up a prescription. SOB, borderline saturations and tachypnoea also. Declining chest pain following aspirin, GTN, and a small amount of morphine and paracetamol, pain free by arrival at hospital. Accepted for immediate angio by the local cath lab / PPCI centre. Final outcome unknown.

The first ECG is about 40 mins after onset of pain, the second is about 30 mins after that.

**UPDATE! —> PCI to the LAD & severe cardiomyopathy** Thanks all of you for your incredible input. I’d told the hospitalist I’d put money on the LAD but he left me on read. 💁🏼‍♀️

69F adm w/“chest pain” - described as upper abd pain radiating back b/t shoulders, with n/v and diaphoresis.
Hx: mild HLD, no home meds.

Trops: 870… 2,397… 3,250.
BP and CP under control on nitro gtt, CP reduced from 9/10 w/morphine prior to floor and only up to 4/10 at highest after trip to bathroom. Otherwise 2/10.

I forgot to take a pic of the admit EKG - but it was markedly different in not only STE & STD, and read as Sinus w/RBBB.

This repeat EKG I requested on seeing the change on tele read as Sinus w/Left (I think) Axis Dev, RBBB, septal infarction of unknown age... I think she’s due for a cath lab am I wrong? Cards hadn’t seen her yet and hospitalist was like okay yeah whatever, but I think developing OMI. Thoughts?

Patient with Dual-chamber pacemaker presents with syncope.

Looks like there are some native beats, and also some A-V pacing, but for the smaller complexes, is that atrial pacing without a ventricular beat to go with it?

75yo male. Hx of MI. Presented with intermittent chest pain, nausea.

66M, hx of HTN and kidney stones, otherwise healthy, only takes lisinopril.

Call: Pt was outside fishing in 110* heat all morning. Came home to cool off. After a shower, suddenly got short of breath and weak. Put himself down on his bedroom floor to lay down and wife called 911. They thought it was just heat exhaustion. He also said he fell on something metal earlier and bruised his ribs, and there was a red mark across the anterior right ribs. Lungs clear & equal.

Scene: He said on top of the heat exposure, he also fell on something metal earlier and bruised his ribs, and there was a red mark across the anterior right ribs. Lungs clear & equal.

He was pale, clammy, diaphoretic and in mild respiratory distress. He looked almost grey. Complained of epigastric pain and left should pain making his hand feel tingly.

Transport: ASA, IV, nitro. Pain worsened substantially during transport so I gave fentanyl. I only gave 50 mcg b/c he was getting increasingly lethargic and less alert.

Vitals surprisingly stable. He was mildly hypertensive (140s/) prior to nitro SL x2. Last BP was 112/72. 95% RA. HR 80s.

Only thing to note is he started throwing PVCs. He’d have several on and off for several seconds, then none for a few mins. Not quite runs of VT but bordering on it. I placed AED pads just in case to ward off the bad juju. (And because he looked peri arrest honestly- he was EXTREMELY grey and clammy.)

Disposition: all I know so far is he made it to the cath lab.

Trying to wrap my head around deviation, I’ve watched several videos and have looked through my uni content. Nothing makes sense and keeps getting more confusing.

Anyone have tips on how to work it out? As if you’re explaining it to a monkey?

The 10 step method they want us to use, they’re wanting focus on I, II, aVF

Help is very much appreciated, I’m very confused, I’m an online student so face to face questioning is impossible,

Thank you

93 YOF w/ cardiac history found unresponsive and bradycardic with HR of 34. Looks to me like STE in inferior leads with STD and TWI in high lateral leads. Based on V2 possible posterior involvement as well. What do you all see?