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?
A bunch of little things abnormal with this ECG
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.
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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