55 y/o female, new onset hypertension with history of anxiet | Figure 1

55 y/o female, new onset hypertension with history of anxiety, otherwise healthy. Attending says a-flutter, but I see p waves before each qrs. What do you see? Sorry for image quality.

Cases

20 yr male, prev healthy, fit and lean.

• Comes in at 4am with chest pain from 1.30am.
• Constant, pressure type. Radiates up to left side of neck.
• Afebrile but is shaking. Complains of light nausea and dyspnoea.
• Bp 120/68 pulse 77 SaO2 98 resp 20.
• No family known history of cardiac disease. What do you guys see in this ECG?

70 yr old white female

• Does not want to take blood thinner but takes Flecainide 100mg daily and 3.75 mg Tranxene PRN for anxiety.
• Patient has dextrocardia with complete situs inversus. Never had cardiac cath.
• Not over weight, no diabetes, no other known medical problems.
• Exercises regularly. Non smoker, non drinker, no illicit drug use. What would be best treatment besides what she is already being treated with?

NEW doc said STEMI

• w/reciprocal changes. I don't see it irrefutably.
• If someone could explain...I was under the impression that MIs were rarely tachycardic...and research supported that.
• No cp, just tachypnea and anxiety...

CLTmedic 89yo independent female

• Patient c/o period of anxiety, chest pain, feeling like she was going to "choke" while eating dinner.
• Hx of dementia and osteoporosis, family denies any cardiac Hx or medications.
• Pt is currently being treated for pneumonia, #Doxycycline x2 days.
• Pt was complaint free for EMS. Irregular, rapid pulse.
• Lung sounds were clear with mild fine rales. V/S 135/96, HR 130-180, RR 24, SpO2 93-95% RA, afebrile.
• --- pic 1: initial rhythm strip. Pic 2: initial 12 lead. Pics 3&4: continuous rhythm strip 3 min after pic 2, without any intervention. Pic 5: 12 lead following

Trending Now

A 52-year-old man

• Presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
• He had a history of hypertension, long-term smoking, and a sedentary lifestyle.
• On physical examination, bibasilar crackles were noted on lung auscultation.
• An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman

• Presented with a 3-day history of intense pruritus over the lower back.
• She reported no recent travel or exposure to new environments.
• She cares for a small kennel with approximately eight dogs rescued from the streets.
• Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant

• Presented with skin lesions localized to the chin for the past 3 days.
• Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens

• Presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family.
• Are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?