EKG Case 8 – All that wheezes

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.