50 year old with chest pain and shortness of breath. What do you think? #ECG #EKG #foamed #MedEd #MedstudentTwitter #resident #Paramedic #nurse #cardiotwitter #EmergencyMedicine
⏱️ HR: sinus tach ⚡️Electrical: RBBB 🧭Axis: right 📈R-wave: early from RBBB 🔋Tall/small voltages: normal 💔ST/T: secondary repol changes = CP/SOB with sinus tach, RBBB and right axis. CT showed large PE
@heartsECGcourse ①SⅠQⅢTⅢ pattern ②Negative TW(Ⅲ>Ⅱ) ③Sinus Tachycardia ④RVH, RAD ➥Acute Pulmonary Embolism
@heartsECGcourse Acute PE. Sinus tachycardia, RBBB, TWI in inferior leads. ? Massive/saddle - urgent CTPA
@heartsECGcourse STachy. RVH. inverted T in II,III but III>II. RV strain. PE vs inferior MI, I am leaning toward PE. What labs do you have? PhysExam? I'm not inclined to diagnose solely from EKG.
@heartsECGcourse Sinus tachycardia, RBBB, right heart strain. Massive PE
@heartsECGcourse Ha. Interesting. It surely looks like both (PE and inferior STEMI). STEMI is less likely to have a rightward axis. I am going to go with PE and treat pt in this order: ASA, heparin drip, CTA, then cath lab.