ECG Cases 35 – ECG Approach to Takotsubo Syndrome

Takotsubo Syndrome is usually triggered by an emotional or physical stress leading to acute catecholaminergic myocardial stunning. The initial ST elevation phase of Takotsubo Syndrome mimics Occlusion MI, can not be distinguished by patient factors or POCUS findings, and requires immediate angiogram. The subsequent phase of Takotsubo Syndrome has T wave inversion in an apical distribution, which can mimic reperfusion, but often has very deep T wave inversions and a very long QT interval. Takotsubo Syndrome is a retrospective diagnosis of exclusion—with an angiogram ruling out occlusion, a ventriculogram showing apical ballooning, and a follow up echo showing recovery of LV function. Complications of Takotsubo Syndrome include LV failure, apical thrombus, and polymorphic VT from long QT. Jesse McLaren guides us through 10 ECGs to elucidate these important take home points...

ECG Cases 34 – ECG Interpretation in Aortic Dissection

Which patients with ECG evidence of coronary occlusion require a CT scan to rule out aortic dissection? What are the range of ECG findings in acute aortic dissection and how do they change management? Dr. Jesse McLaren guides us through 9 cases to answer these and other questions on ECG interpretation in aortic dissection...

ECG Cases 32 Prehospital ECG pearls and pitfalls

In this ECG Cases blog we review 8 cases of patients with prehospital ECGs and explore prehospital ECGs for diagnosing STEMI, Occlusion MI, false STEMI, code STEMI, dynamic ischemic changes, truncated voltages. Can you avoid the pitfalls and spot the pearls that help to make the diagnosis?

ECG Cases 31 Is a 15 lead ECG better than 12? Diagnosing Posterior MI and RVMI

Is 15 lead ECG better than 12 lead for diagnosing posterior MI or right ventricular infarction? When do you need a 15 lead ECG? Jesse McLaren guides us through 8 cases to highlight the steps and pitfalls in diagnosing posterior MI and RVMI in light of recent ECG literature...

ECG Cases 30 Beware Computer Interpretation Errors

Computer interpretation of the ECG has been called a double-edged sword: when correct, it increases physician accuracy, but when incorrect it increases errors. This is especially problematic in the emergency department, where computer accuracy drops as clinical significance increases—with common errors for arrhythmias and ischemia. Jesse McLaren guides us through 10 cases where the computer interpretation misguides us and how to avoid these pitfalls...

ECG Cases 29 Misdiagnosis from Lead Misplacement, Artifact and Lead Reversal

In this ECG Cases blog we review 10 cases of possible artifact, lead reversal and lead misplacement. Can you spot the abnormalities and avoid the misdiagnosis?...

ECG Cases 27 Pericarditis – Diagnosis of Exclusion

Jesse McLaren guides us through 9 cases and explains how pericarditis is a diagnosis of exclusion through 3 simple steps: 1. Exclude more serious causes of chest pain, eg wraparound LAD occlusion, inferior OMI 2. Exclude complications of pericarditis, eg myocarditis, large pericardial effusion 3. Exclude normal variant ST elevation presenting with benign chest pain on this month's ECG Cases blog...

EM Quick Hits 31 NG Tubes in SBO, Hyperacute T-Waves, Malignant Otitis Externa, CCTA in NSTEMI and Low-risk Chest Pain, Canadian Syncope Score

In this month's EM Quick Hits podcast: Justin Morgenstern on the evidence for NG tubes in SBO, Jesse MacLaren on recognition of hyperacute T-waves vs other causes of tall T-waves, Brit Long on malignant otitis externa clinical pearls, Salim Rezaie on the value of CCTA in NSTEMI, Justin Morgenstern on the value of CCTA in low-risk chest pain, Hans Rosenberg on how to use the Canadian Syncope Score and it's validation in Canada...

ECG Cases 24 Reciprocal Change and Occlusion MI

Dr. Jesse MacLaren reviews 10 ECG cases highlighting how reciprocal change can be secondary to LBBB/LVH, primary changes, or both, how it can be the first and remain the dominant sign of occlusion, pointing to subtle ST elevation or hyperacute T waves, how it can can highlight subtle inferior, lateral or proximal LAD occlusions, how it can be the only sign of posterior OMI; and how it can be absent in mid-distal LAD occlusion...

ECG Cases 23 – Wellens syndrome, reperfusion and reocclusion MI

Eight patients presented with potentially ischemic symptoms and T-wave inversions. Which had occlusion MI, which were reperfused and which were reoccluded? Jesse McLaren helps you discover the nuances of Wellens syndrome and T-wave inversions on this month's ECG Cases blog...

By |2021-07-13T12:27:47-04:00July 13th, 2021|Categories: Cardiology, ECG Cases, Emergency Medicine, Medical Specialty|Tags: , , , |0 Comments
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