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Myocarditis is simply an inflammation of the heart muscle, that can lead to myocardial cell damage, myocardial dysfunction and heart failure. A Recent Case A 15 yo male presents to the emergency department with sharp central chest pain that is worst on inspiration. The pain has woken him from sleep. There is no radiation although…

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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…

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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….

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A 9 year old girl with syncope

The Case A 9 yo girl is brought into the emergency department, following an episode of syncope. She has a current viral illness and looks miserable. She was walking into the Emergency Department with her mother, when she collapsed. She recovered quickly with no post ictal component but also had no memory of the event, although the…

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How To Read The Paediatric ECG

Below is an ECG taken of a 0ne week old infant, who has some shortness of breath whilst feeding according to the parents. What does it show? Is it normal?ECG’s can already present a significant challenge, however there is a fear associated with the paediatric ECG. There should not be, as the same principles that…

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De Winter’s T waves

De Winter’s T Waves were first described by De Winter in an article to the editor of the New England Journal of Medicine in 2008(1). They are considered an ST-elevation myocardial infarction(STEMI) equivalent and knowledge of this sign is important as ST depression  is not the classic appearance of an STEMI. Using ECG’s from a large…

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Pericarditis, Benign Early Depolarisation or STEMI

Differentiating between Pericarditis, Benign Early Depolarisation and ST Elevation Myocardial Infarction can sometimes be difficult. CASE A 35 yo male presents with palpitations and pleuritic chest pain. He’s recently had a viral illness but has no other medical history. At 1am in the morning, the patient was woken by palpitations. He now complains of left…

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Clinical Pearl- Hypertrophic Cardiomyopathy

A 24 year old male presents following a syncopal episode. On cardiovascular examination you believe there is a systolic murmur. Given his history and a family history of his father having a ‘large’ heart, you are suspicious of cardiomyopathy. How can you assess on clinical examination if the murmur is that of cardiomyopathy? I know…

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The Slam Dunk ECG!

Hi all. This is a case from a few days ago. I loved it, as it was one of those slam dunk diagnosis, even when everything looked normal, thanks to the ECG. A 63 year old woman presents with sudden onset of shortness of breath. It began, whilst she was in the supermarket, shopping. The…

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Left Ventricular Hypertrophy

Left Ventricular Hypertrophy(LVH) can cause all sorts of problems in terms of ECG diagnosis. There is a straightforward and simple approach to diagnosing it. Here is the ECG in 20 Seconds Approach. The criteria for diagnosing LVH are very specific(>90%) but not sensitive(50%). That means that if the criteria are met, it’s probably there. If…

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Inferior infarct: what else to look for

In this video, Dr Sam Bendall presents one of many cases at our ECG workshop. This is now in our CARDIAC COURSE. This case involves the patient with inferior infarction and what else to look for, including posterior infarction and right ventricular infarction with a reminder to think of dissection. The management of these patients is…

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Sinus tachycardia or is it flutter?

A 39 year old woman presents to the Emergency Department with palpitations. She has seen her local doctor 3 days previously with the complaint of a ‘racing heart’. The local doctor has done an ECG in the practice, diagnosed Atrial Flutter and commenced a beta blocker; ‘Metoprolol’. The patient now presents to the Emergency Department because her heart is still ‘racing’.
Following some investigations this patient is sent home.[…]

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