Cheap chest pain + weird ekg

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A 70s F presents with chest pain last night (it is now 9:30 pm).  She has no cardiac hx and it’s a cheap chest pain story.  Her pmh includes diabetes and htn.  She is noted to be bradycardic at triage.  The remainder of her exam is normal.  An ekg is done.  What do we do now?


  • himynameisvince

    Obviously it’s a Tylenol overdose.
    Jk, perhaps infero-lateral STEMI equivalent because of inappropriate concordance. I think for most of these LBBB EKGs + atypical CP history, I would page Cardiology and fax EKG rather than MEHEART. Perhaps patient is bradycardic because she’s on a beta-blocker?

  • Sammy

    No way! Put an Ultrasound over the heart!!! J/k I agree with Vince, fax/page cardio instead of jumping to MEHEART. Could be Stemi equivalent but also think about K! “Hyperkalemia on ECG is like Syphillis (ask Vince about his Infection), it can present in any weird ways.” Just give calcium, send stat K, pacer pads. Pace if unstable. Then Ultrasound. Lol

  • alvarezzy

    1. repeat an ekg to see if it’s evolving.. doesn’t seem to correlate with story and almost dewinter’s ekg.

    what’s the blood pressure? temperature?

    a. at one shop, we have high sensitivity trop. if positive, cards.
    b. at another shop, regular trop, then admit.
    c. at community, same as b.

    doesn’t meet stemi criteria so no need to ring the alarm bells.

    agree with K+ level.

    lemme guess. dissection.

  • Anki

    This is slow Afib.
    Ddx: dig tox,
    hyperkalemia 2/2 meds/ renal failure.
    I would get an I-stat.
    Put pads on the pt.
    give Calcium gluconate to stabilize the cardiac membrane.
    If K is high treat it.

  • Tonynap

    Less likely beta blocker because chest pain is the chief complaint (beta blockers cause all kinds of cardiac manifestations but rarely chest pain.
    Check a k or a trope in. If cardiac worry about lesions of the proximal LAD (first septal perforator supplies ant 2/3 septum) less likely RCA/IW unless base rhythm LBBB. Definitely check a K and other lytes

  • Tonynap

    And in diabetics, especially old diabetics, all bets are off. she doesn’t have to present classically. Full tilt cards consult regardless of the institution

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