24yo F presents with SOB, wheezing and chest tightness. Exam shows tachycardia and wheezes. The above EKG is obtained. What is your DDx? Any other information about the patient you would like to know?
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nchristopher
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2 Comments
andygrock · June 26, 2013 at 11:45 pm
I’m would be more offended that more people haven’t responded, but hey, I guess the gift card is mine.
DDx from history/physical: pericarditis (my favorite is Tb pericarditis), myocarditis cor pulmonale, eisenmengers/chf, asthma, PE, pulmonary htn (hereditary vs from OSA), pna, crack lung, COPD (likely from alpha 1 trypsin insufficiency), ACS (higher risk due to sickle cell anemia/family history), restrictive lung disease due to severe scoliosis, cardiac contusion s/p trauma, atelectasis leading to V/Q mismatch from…chronic heroin use/rib fx/being fat.
EKG: Rate: 12ish
Rhythm: regular, sinus
Axis: nml axis
Intervals: QRS nml (if you squint hard and make believe maybe a delta wave seen best in AVF), PR short to nml (hard to see little lines), QT likely nml (looks nml in AVL, but difficult to tell where T wave ends in II/III making QT calculation difficult)
T waves: inverted in II/III/AVF, V1/V2/V3/V4
P waves: possibly different waveforms…(MAT?) P wave in II appears abnormal, but is upright).
ST-T – no obvious ST elevation/depression.
No electrical alternans
Decent R wave progression
General interpretation: sinus tach (pain/PE/CHF?), MAT, Very soft call for wpw,
Things I want: Prev EKG, PMHx, is she fat?, fever?, recent travel?, PQRST for symptoms?, tachypnea?, PERC/Wells score, Echo done by Dr. Christopher (I hear he gets apical 5 every time…), CXR, ABG/O2 sat.
mritchie · July 2, 2013 at 5:48 am
My interpretation:
Rate: 114
Rhythm: Sinus Tachycardia
Axis: Normal
P waves: no signs of atrial enlargement
PR interval: normal
QRS: Narrow
No Q waves
LVH by criteria
Good R wave progression
ST segments: no elevation or depression
T waves: Flipped in II, III, AVF, V1,V2,V3,V4,V5
My guess on the diagnosis would be pericarditis.