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A young man with persistent palpitations
Written by Pendell MeyersA teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms....
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Acute dyspnea in an older woman, is it OMI?
Written by Willy FrickA woman in her 90s with a history of end stage renal disease and complete heart block status post dual chamber pacemaker presented from home with acute onset dyspnea. ECG is...
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Tachycardia and hyperkalemia. What will happen after therapy with 1 gram of...
A 20-something type, 1 diabetic presented by EMS with altered mental status. Blood pressure was 117/80, pulse 161, Resp 45, SpO2 100 on oxygen.Here is the 12-lead ECG:Wide complex tachycardiaWhat do...
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How will you save this critically ill patient? A fundamental and lifesaving...
Written by Pendell MeyersA woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill,...
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"Seizure" in a 60 year old male
This 60 yo male had an apparent tonic clonic seizure. He had no history of seizures. He was unconscious for 8 minutes and slowly awoke in the ambulance, complaining of nausea only. First responders...
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When the conventional algorithm diagnoses the ECG as COMPLETELY NORMAL, but...
I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia.I have collected 51 OMI cases that were diagnosed...
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Young man with Gunshot wound to right chest with hemorrhagic shock, but...
A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock.He got a chest tube and intubation and massive transfusion and stabilized.CT of chest showed...
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Acute chest pain and ST Elevation. CT done to look for aortic dissection.....
Written by Willy FrickA 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. He had associated nausea, vomiting, and dyspnea.What do you...
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A man in his 40s with 3 days of stuttering chest pain
Written by Willy FrickA man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a...
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Three patients with chest pain and “normal” ECGs: which had OMI? Which were...
Written by Jesse McLarenThree patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation...
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Why is the angiogram normal?
Written by Willy FrickA man in his 50s with a 15 pack-year smoking history presented to his primary care physician's office complaining of intermittent headache. He also complained of intermittent mild...
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An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest...
This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System.The patient presented to an outside hospitalAn 80yo female per triage “patient presents with chest pain,...
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A 50-something with chest pain. Is there OMI? And what is the rhythm?
Written by Willy FrickA man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and...
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Palpitations and presyncope in a 40-something
Written by Magnus NossenThe below ECG is from a 40 something male with no past relevant medical hx. The patient contacted EMS due to sudden onset chest pain, palpitations and lightheadedness. Symptoms...
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A man in his 50s with shortness of breath
Sent by Tom Fiero, written by Pendell Meyers A man in his 50s presented with acute shortness of breath. Unfortunately we do not have access to the patients presenting vital signs.Here is his...
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Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT...
A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via...
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What happened after the Cath lab was activated for a chest pain patient with...
Sent by anonymous, written by Pendell MeyersI received a text with this image and no other information:What do you think?I simply texted back: "Definite posterior OMI." The person I was texting knows...
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Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified...
An elderly man collapsed. There was no bystander CPR. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then...
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A young woman with chest pain, cath lab activated
This case came from a friend whose sister was the patient. She knew I was interested in ECGs, so she took a photo of this one.A young woman presented with acute chest pain.This was her presenting...
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A 29 year old male with chest pain, ST Elevation, and very elevated troponin T
By Magnus NossenThis ECG is from a young man with no risk factors for CAD, he presented with chest pain. How would you assess this ECG? How confident are you in your assessment? What is your next step?...
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56 year old male had 5/10 chest pain for several hours, then presented to the...
A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night.He reported chest pain that developed several hours prior...
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The current STEMI paradigm: Because STEMI criteria are not met, let's wait...
This was sent to me by an inpatient nurse who reads this blog but wants to remain anonymous.An inpatient rapid response was called for a patient with hypotension. The patient was originally admitted...
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Is OMI an ECG Diagnosis?
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm,...
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Chest pain, resolved. Does it need emergent cath lab activation (some...
A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting...
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Take the OMI Quiz and Test yourself against the Queen of Hearts
QuizThe PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days. Do you think you can outperform the toddler version of the AI model? Version 2.0 will...
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