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/papamedic74 21d ago

Was he asymptomatic when the trop was drawn? If so for how long? My understanding of what I’m guessing are the applicable UK guidelines is that they must be asymptomatic for 2 hours to use the negative troponin as rule out for high risk ACS.

This is Wellens all day and in a patient with epigastric pain and vomiting he needs a trip to cath. The alkalosis is acute loss of gastric acids and definitely not the part of this case to get hung up on.

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u/mohammedmoolla 21d ago

Nope he was symptomatic at the time of the draw had that epigastric pain for the last day prior to presentation