{"id":694,"date":"2017-03-13T13:42:19","date_gmt":"2017-03-13T13:42:19","guid":{"rendered":"http:\/\/torreyekg.com\/?p=694"},"modified":"2017-03-13T13:44:27","modified_gmt":"2017-03-13T13:44:27","slug":"ekg-of-the-week-46","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2017\/03\/13\/ekg-of-the-week-46\/","title":{"rendered":"EKG of the Week #46"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/46.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-695\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/46.png\" alt=\"\" width=\"648\" height=\"368\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/46.png 648w, http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/03\/46-300x170.png 300w\" sizes=\"auto, (max-width: 648px) 100vw, 648px\" \/><\/a>28-year-old obese man presents after syncope and with this EKG. He is hypotensive at 78\/46. Thoughts and plans?<\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Answer &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nHis level of hypotension seemed unusual for an acute septal MI, especially in an otherwise fairly healthy young man. He had no chest pain, just some shortness of breath.\n<p>78\/46\u00a0\u00a0 110\u00a0\u00a0 28\u00a0\u00a0 O<sub>2<\/sub>sat 92% on RA\u00a0\u00a0 afebrile<br \/>\nlungs \u2013 clear bilaterally<br \/>\ncor \u2013 regular, no murmur appreciated<br \/>\nextremities \u2013 no edema, diminished distal pulses<\/p>\n<p>RUSH (Rapid US in Shock) exam revealed a massively dilated right ventricle. When asked about leg pain, he described significant pain in his right calf for 2 days. Ultrasound of the right popliteal area revealed a non-compressible vein with intramural clot. STAT CT angiogram revealed large bilateral pulmonary emboli. This patient received TPA in the ED and has done well.<\/p>\n<p>While PE has no definite EKG findings, it is a great masquerader\u2026it can present with T-wave inversion anteriorly (small or giant T-wave inversion) and with ST-segment elevation on occasion. Keep PE on many differentials, especially when the EKG findings don\u2019t quite fit with the clinical presentation.<br \/>\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>28-year-old obese man presents after syncope and with this EKG. He is hypotensive at 78\/46. Thoughts and plans?<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-694","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/694","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=694"}],"version-history":[{"count":4,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/694\/revisions"}],"predecessor-version":[{"id":699,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/694\/revisions\/699"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=694"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=694"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=694"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}