[Max Sobrero]

A 65 yo M with pmh DM, HTN, CKD is BIBEMS after roommate witnessed syncopal event x 2. Patient repeatedly denies this but admits he has been feeling “a little weaker” over the past several days. He otherwise denies fever, chills, n/v, CP, SOB, DOE, bloody stools/melena. He would like to go home as soon as possible but is willing to be evaluated by you.

VS 37C, 160/80, 110, 24, 95%RA

Appears slightly diaphoretic and a little pale but otherwise unrevealing exam.

What is your interpretation of his initial EKG? What are your next steps?

[amasingh@alamedahealthsystem.org]

A bunch of little things abnormal with this ECG

sinus tachycardia

S1Q3 with maybe a T3

STE in aVR and V1

mild diffuse STD in I, II, aVL, aVF, V3-V6

the R wave transition is early

and there is a PAC with normal conduction and a PAC with aberrant conduction

I vote PE – this ECG has 3 of the 5 common signs consistent with PE.

[Max Sobrero]

Thanks, Deep! Final chance for residents to chime in before the answer is revealed…

Anything else you’d want to know or do? How would you work this up?

Hint: Deep is *really* good at interpreting EKGs…

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