Rhythm Nation: March 2017

It’s Sunday morning 10 am and a patient finally pops up on the whiteboard: “19 Y M, CHEST PAIN.” Your favorite.

The patient is a 19 year-old man with no PMH BIBEMS with chest pain. He lifted weights yesterday, and this morning woke up with soreness in his mid chest area that resolved on its own. There was no associated dyspnea, hemoptysis, pleuritic chest pain, or diaphoresis. On further questioning, he denied any recent travel, leg swelling, history of cancer or cardiac risk factors or any family history of early death or MI. This was his first time ever experiencing such pain, which scared him and promoted him to come to your ED. Currently, he is asymptomatic and a little embarrassed.

ROS: As stated above

PMH: None

PSH: None

SHx: Only drinks alcohol occasionally
FHx: noncontributory

Medications: None

Allergies: NKDA

 

Physical Exam:

Triage VS: T 982.F, HR 56, RR 18, BP 140/79, O2 100%

General: Well-appearing young man, NAD, lying comfortably in bed

HEENT: NCAT, PERRLA, pupils 3mm bilaterally, EOMI, MMM, neck supple

CVS: RRR, S1/S2, no murmurs/rubs/gallops, no chest wall tenderness

Chest: CTAB, breathing comfortably

Abd: Soft, NTND, normoactive bowel sounds

Msk: No edema, pulses 2+ in all four extremities

 

Ready to send this young man home, you quickly glance at his triage ECG and see this:

Discuss the ECG findings.

  1. What is the abnormal finding?
  2. With what condition is this finding associated? How sensitive and specific is this finding?
  3. What would be your next step in management of this patient?
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slee

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3 comments for “Rhythm Nation: March 2017

  1. eschnitz
    March 20, 2017 at 1:13 pm

    its hard to zoom in to see but I think I see S1Q3T3. associated with right heart strain. still likely low wells <4 so i'd get a dimer.
    NSR with normal axis. normal intervals (maybe a short QT cant really tell)

    • Brian
      March 20, 2017 at 8:46 pm

      Try now.

  2. eschnitz
    March 21, 2017 at 1:31 pm

    maybe some hyperacute t waves in the high lateral leads (I,AVL) but i could be digging but i’d send a trop also with the dimer.
    Or i could just be completely overworking this 19 y/o but i’m curious now

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