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Elder Male with Syncope

EMS 12-Lead

2. Coronary angiography reveals significant and severe CAD involving all three epicardial vessels. Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates). Abnormal gated wall motion of the LV with an ejection fraction of 18%. Type I ischemia.

Coronary 290
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Wide Complex Tachycardia

EMS 12-Lead

He denied any known history of CAD, but did report ASCVD risk factors to include HTN, HLD, and DM. I interpreted the ECG as VT with two primary etiological possibilities: 1. Abrupt plaque ulceration of Type 1 ACS leading to VT.

CAD 147
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. Smith comment : Is the ACS (rupture plaque) with occlusion that is now reperfusing? Edited by Smith He also sent me this great case.

CAD 124
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Formula Utilization

EMS 12-Lead

Moreover, he had no pertinent medical history to report in terms of CAD, HTN, HLD, or DM, for example. Although the attending crews did not consider the ECG pathognomonic for occlusive thrombosis, they nonetheless considered the patient high-risk for ACS and implored him to reconsider. A 12 Lead ECG was recorded.

ACS 130
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SGEM#370: Listen to your Heart (Score)…MACE Incidence in Non-Low Risk Patients with known Coronary Artery Disease

The Skeptics' Guide to EM

The bottom line from that episode was that the HEART Pathway appears to have the potential to safely decrease objective cardiac testing, increase early discharge rates and cut median length of stay in low-risk chest pain patients presenting to the ED with suspicion of ACS. If we thought about ACS, we brought them in. AEM June 2022.

Coronary 100
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OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.

Dr. Smith's ECG Blog

He did have a family history notable for early CAD. A final ECG was perfomed on hospital day 2: Persistent ST elevation in the inferior leads with slight reciprocal ST depression in aVL Teaching points - It is essential to consider ACS in all age groups. He denied drug or alcohol use. ng/mL (ULN 16,000 ng/L, mildly elevated CRP of 8.4

Coronary 114
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An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain

Dr. Smith's ECG Blog

The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System.

CAD 90