Monday, February 2, 2015

EKG Challenge No. 9: A generally unimpressive case of chest pain ...

You are working a typical shift in the ED when an otherwise healthy 33 yo male presents with 2 hours of chest pain. He reports  ~3-4 episodes of vomiting over past few days as well as myalgias & subjective fevers.  Two hours prior to arrival, he awoke with mid-sternal chest pain.  The chest pain is burning in quality, non-radiating, worse with deep inspiration. He denies any current nausea or SOB, prior history of similar episodes or calf swelling or pain. You are general unimpressed,  but of course get the EKG anyway:

What do you think is going on?  What would you do next?  Click here to read the Case Conclusion.


  1. Ant. STEMI w/ elevation V1-3 and subtle recip Depr II, aVF

  2. The ECG suggests Brugada Syndrome, although it is hard to sort out why this presents now. While problems with sodium channel conduction with Brugada are genetic, the syndrome can be precipitated by fever, drugs both prescribed as well as alcohol and cocaine. TCA overdose also has ECG manifestations in the early precordial leads consistent with Brugada.

  3. what a nice Piece of blog....
    good... keep it up.

    Usmle Tutor

  4. The slope and coving in the anterior leads along with the history are suggestive of Brugada. Of course one needs to rule out an anterior STEMI.