• Home
  • /
  • Cardiology

The Unstable Atrial Fibrillation Patient

THE CASE A 75 yo man is brought into your small rural ED after 3 hours of ischemic chest discomfort.  His background is significant for hypertension, a CVA 5 years ago for which he is on aspirin/dipyrimidole, and 2 coronary artery stents in 1995.  The ambulance officers found the patient to be in AF, with…

Read More

Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

Read More

A patient with nausea, vomiting and lethargy

(Please note this is a free view of this week’s ‘own the ecg‘ blog. Enjoy). A 79 year old man presented to the emergency department with a 2 day history of nausea, vomiting, lethargy and left abdominal pain. He appeared pale, clammy and unwell. His initial observations revealed a pulse of 50/min, BP 170/87, sats of…

Read More

Seizure, Syncope and Sudden Collapse

Associate Professor Peter Kas presents Seizure, Syncope and Sudden Collapse. The patient with syncope or presyncope becomes a challenge in the emergency setting. Although this diagnosis is reported to comprise 5% of emergency presentations, it seems like so much more than this. This lecture looks at the definition of syncope, which comprises three elements: a sudden…

Read More

Age-Adjusted D-dimer for ruling out pulmonary embolism

We use D-dimer in patients with a low probability of a pulmonary embolism, to rule out the condition and thus avoid imaging. The level of D-dimer rises with many conditions and also with age, thereby reducing it’s specificity for this condition. In a retrospective cohort study of D-dimer cut-offs, Ackerly et al(1)  compared three proposals for…

Read More

VT vs SVT with Aberrancy

The following ECG was sent to me recently. It’s a great case and a situation that we can all be faced with. The question is: Is this VT or SVT with Aberrancy? The further question is; What do you do when your treatment isn’t working? An 80 year old male presents feeling unwell with palpitations….

Read More

The ECG of Athletes: Normal variations you must know.

The ECG of the athletes can pose a challenge in distinguishing pathological changes from those physiological changes, that are associated with physical training and cardiac remodelling. We don’t want to erroneously attribute heart disease to those with normal variants and more importantly, we don’t want potentially life threatening cardiac conditions being erroneously dismissed as normal…

Read More

Cardiogenic Shock: Which Vasopressor to use

In the patient who presents with cariogenic shock, the cath lab and a stent or a CABG is probably the treatment of choice, however we don’t always have those luxuries. What inotrope(s) do we use in cariogenic shock? How do we approach those patients for the best outcome? Here is a recent case. It is…

Read More


Syncope is one of those conditions you either love or hate. I certainly have at least five presentations of patients with syncope per shift. Having an approach to those patients certainly helps minimise missing the big stuff. Remember that syncope is a symptom and we need to find the diagnosis. The detective work is about…

Read More

Wellen’s Syndrome

Wellen’s Syndrome is one of those syndromes that all emergency physicians know about. It’s probably also one of those syndromes that the emergency community introduced to clinicians everywhere. It was first described as an inverted U wave as early as 1980 and then introduced by Wellen in 1982 as Wellen’s syndrome, the name by which…

Read More

Spodick’s Sign and Pericarditis

Spodick’s Sign appears in Stage I of Pericarditis and is a downsloping of the TP line ie., the baseline. It is said to be present in some 80% of cases of acute pericarditis and is best visualised in lead II and the lateral precordial leads(1).       The ECG findings of pericarditis are important…

Read More
Email Updates
Get the latest updates on our Conferences PLUS Webcasts and Education Newsletters.
We respect your privacy.