A patient with Parkinson’s disease presents with chest pain to your ED. Her tremors prevent you from getting a good quality EKG because of the movement artifact.
How can you eliminate this artifact? (No cheating with rocuronium.)
Brugada, Brugada, Brugada
You always hear about it when working up syncope and sudden cardiac arrest in young patients, but it’s so easy to forget what it looks like on ECG. We so rarely see it… or DO we?!
This Paucis Verbis card on Brugada Syndrome is to help emblazon these ECG tracings in our mind, so that we don’t miss the subtle findings which place a patient at risk for sudden cardiac death. Pay special attention to Type 1, which is most specific for Brugada Syndrome.
Sometimes a picture is worth MORE than a 1000 words. Such is the case of the above illustration that I saw on the Life In The Fast Lane blog. When I first saw it, I knew that I immediately had to find out who made the graphic. It turns out it is the multitalented Dr. Tor Ercleve, who is an emergency physician at Sir Charles Gairdner Hospital and an established medical illustrator.
This graphic demonstrates the EKG findings for the various types of acute MI’s as broken down by coronary vascular anatomy (right coronary artery, left circumflex artery, left anterior descending artery). This detailed illustration won’t be readable in print form but is great in digital format on your mobile device.
Thanks, Tor!
[PDF]
A standard 12-lead EKG can be very telling for patients with chest pain or shortness of breath. A right ventricular (RV) and posterior wall infarct, however, can present very subtly. You can obtain special right-sided (V1R-V6R) and posterior leads (V7-V9), if you are concerned.
Patients with a hairy chest may require little patches of hair to be shaved when applying EKG leads. This allows the leads to stick firmly to the chest. Loose leads will result in either an artifactual signal or no signal at all on the EKG machine.
How can you obtain an EKG without shaving little patches on the patient’s chest?
It is difficult to determine if a patient with a left bundle branch block (LBBB) has an acute myocardial infarction (AMI) because ST segments are “appropriately discordant” with the terminal portion of the QRS. That means if the QRS complex is negative (or downgoing), the ST segment normally will be positive (or elevated). Similarly if the QRS complex is positive (or upgoing), the ST segment will be negative (or depressed).