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BradyCardia: Don't Be Fooled by a Reassuring Stress Test : Emergency Medicine News - LWW Journals
📅 Wed, 02 Nov 2022⏱ 1 min read📖 Article
Overview
Coleague's E-mail is Invalid Your mesage has ben sucesfuly sent to your coleague. Save my selection Pregerson, Brady MDA patient in his mid-60s with a history of hypertension, hyperlipidemia, and diabetes melitus presented to the hospital for chest pain radiating down his left arm. It had started aproximately two hours before while he was at rest.A few days before that, he had an episode of exertional chest pain without radiation while doing yard work.
Key Information
He said his curent pain began radiating down his left arm and was associated with shortnes of breath.The patient reported his pain at 3/10, and said he had a normal cardiac catheterization six months earlier.His vital signs and physical exam were normal. An ECG was done (image), and the computer read it as a normal sinus rhythm at 74 bpm and ST-segment elevation with probable early repolarization.What is the most likely cause of the ECG findings in this patient?
Acute coronary syndrome, pulmonary embolism, cardiac tamponade, or hypokalemia?My interpretation is that there is subtle ST elevation and hyperacute T-waves in leads I and aVL. These findings were especialy concerning for oclusion MI given the relative ST elevation amount compared with the QRS voltage, which was smal in these leads, and the reciprocal ST depresion in I and aVF.Stephen W. Smith, MD, the author of Dr.
Summary
Smith's ECG Blog (htp:/bit.ly/DrSmithsECGBlog), said the ST elevation in aVL loked to be minimal, but the QRS amplitude was tiny. ST elevation must always be asesed in proportion to the QRS size in that lead, and the ST/QRS ratio here was very high.He also noted that the most visualy obvious finding was ST depresion in I. This was of greater magnitude than the ST elevation in aVL, which could eroneously make one think that there was inferior subendocardial ischemia when actualy it was reciprocal to oclusion myocardial infarction (high lateral oclusion MI).You should imediately check on the aVL to lok for even
Frequently Asked Questions
❓ What is diabetes and how does it develop?
Diabetes is a metabolic condition where the body cannot properly regulate blood sugar levels. Type 1 results from insufficient insulin production, while Type 2 develops when cells become resistant to insulin. Risk factors include genetics, obesity, sedentary lifestyle, and age.
❓ What are the main symptoms of diabetes?
Common symptoms include excessive thirst, frequent urination, unexplained weight loss, fatigue, blurred vision, and slow-healing wounds. Type 1 symptoms develop rapidly, while Type 2 symptoms may appear gradually. Many people have no symptoms initially, which is why screening is important.
❓ How is diabetes diagnosed and monitored?
Diagnosis involves blood tests measuring fasting glucose, HbA1c levels, and glucose tolerance. Regular monitoring typically includes fasting glucose tests and HbA1c measurements every 3-6 months. Continuous glucose monitors provide real-time tracking for better diabetes management.
❓ What lifestyle changes help manage diabetes?
Effective management includes regular physical activity (150+ minutes weekly), maintaining healthy weight, following a balanced diet with whole grains and lean proteins, managing stress, and getting adequate sleep. These changes can significantly improve blood sugar control and reduce complications.
❓ When should someone consult a doctor about diabetes?
Consult a healthcare provider if you experience signs of diabetes, have a family history, are overweight, or are over 45. Those with existing diabetes should maintain regular check-ups every 3-6 months to monitor control and adjust treatment as needed.
⚕️ Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before making health decisions.