1/2. The nondiagnostic ECG in the chest pain patient: normal and nonspecific initial ECG presentations of acute MI.The 12-lead electrocardiogram (ECG) is a powerful clinical tool used in the evaluation of chest pain patients, assisting in the selection of the proper therapy. Unfortunately, the ECG is diagnostic of acute myocardial infarction (AMI) in only one-half of such patients at initial hospital evaluation. In the remaining group of patients with the nondiagnostic 12-lead electrocardiogram, the ECG may be entirely normal, show nonspecific sinus tachycardia (ST) segment-T wave abnormalities, or obvious ischemic changes. In adult chest pain patients treated in the emergency department (ED), 1% to 4% of such patients with an absolutely normal ECG had a final hospital diagnosis of AMI; furthermore, patients with nonspecific electrocardiographic abnormalities experienced AMI in 4% of cases. These findings reinforce the teaching point that the history is the most important tool used in the evaluation of chest pain patients. Furthermore, overreliance on a normal or nonspecifically abnormal ECG in a patient with a classic description of anginal chest pain is dangerous.- - - - - - - - - - ranking = 1keywords = chest pain, chest (Clic here for more details about this article) |
2/2. Sinus bradycardia associated with traumatic haemothorax.A 39-year-old male suffered a closed chest deceleration injury. He presented with clinical and radiological signs consistent with trauma to the thoracic aorta, but also developed sinus bradycardia which was relieved by drainage of a haemothorax. The possible mechanisms of the changes in heart rate are discussed and direct compression of the vagus nerve is proposed to explain this previously unreported finding.- - - - - - - - - - ranking = 0.0029466033802368keywords = chest (Clic here for more details about this article) |