This is the EKG (ECG) for Deepak Patel from scenario SIE003US

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Clinical Picture

  • 64-year old man presenting with light-headedness, nausea and shortness of breath, left shoulder discomfort after rushing due to being late for work.
  • Previous cardiac issues noted, with extensive past medical history,
  • Looks tired and anxious.

Findings

  • Rate: 75
  • Rhythm: Regular
  • Axis: Normal
  • Waves and intervals: No abnormality

Summary 

  • The EKG shows bradycardia with symmetrically peaked T waves.

Differential diagnosis

  • In a patient with cardiac issues, presenting after a period of stress, ST-depression on an EKG indicates a differential of angina.  A myocardial infarction would show more significant EKG changes.  A pneumothorax tends to present with sharp pain, shortness of breath and the patient may have unequal breath sounds on examination. Pericarditis is likely to present over a period of more than two days, and there is no evidence of GI reflux symptoms.

Management

  • In this case Nitroglycerin, oxygen and reassurance are needed.

Further reading

References

  1. Wagner, P., Strodthoff, N., Bousseljot, R., Samek, W., & Schaeffter, T. (2020). PTB-XL, a large publicly available electrocardiography dataset (version 1.0.1). PhysioNet
  2. Wagner, P., Strodthoff, N., Bousseljot, R.-D., Kreiseler, D., Lunze, F.I., Samek, W., Schaeffter, T. (2020), PTB-XL: A Large Publicly Available ECG Dataset. Scientific Data
  3. Goldberger, A. et al. (2000). PhysioBank, PhysioToolkit, and PhysioNet: Components of a new research resource for complex physiologic signals. Circulation [Online]. 101 (23), pp. e215–e220.

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