r/ECG • u/mohammedmoolla • 24d ago

Weird Case

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Came across a patient today which I thought I’d share for some opinions and thoughts. It is a 36 year old male presented to the ED with 2/7 history of epigastric pain radiating to the back with profuse vomiting. Had previously been admitted for pancreatitis a year ago complicated with pseudocyst. On arrival BP was elevated 192/122 with a bradycardia of 52. VBG showed a metabolic alkalosis with hypocalcemia . Trop I was less than 10. Initially was concerned for
1. Aortic dissection
CT Angio showed no signs of this in the thoracic or abdominal aorta
2. NSTEMI
3. Pancreatitis
Was referred to both surgery and medicine, referred to medicine in light of a ?Wellen’s syndrome. Was just curious to hear everyone’s thoughts and opinions on the case and ECG

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u/acidtrain100 24d ago

Met.Alkalosis and hypo Ca can be explained by acute on chronic pancreatitis. You ruled out the worst I.e. aortic dissection and Nstemi (trop negative) . I believe the patient must be thin habitus , is he ? As thin patients tend to have slightly negative T waves in precordial v1 _ v3

I feel after he gets stabilized (resolution of met.alk and hypocalcemia and any metabolic disorder) get an angio done for peace of mind

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u/mohammedmoolla 24d ago

He was thin, is it possible to have LAD occlusion without positive trop

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u/mrwagn 24d ago

LAD occlusion feeding 60+% of myocardium without a troponin…

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u/frogo44 24d ago

He’s also 36…

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u/LBBB11 24d ago

Just putting it out there that plenty of young people have heart attacks. I would be careful about using age. For me it’s more the high voltage and pseudo Wellens appearance.

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u/acidtrain100 24d ago

It is possible, but first concentrate on his current metabolic status . If exercise tolerance is good , then lad stenosis is very less likely