The American journal of emergency medicine
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Electrocardiographic (ECG) artifacts resulting from misplacements of electrodes are frequent, difficult to detect, and can become of clinical importance. We investigated 2 healthy volunteers and 3 patients with ECG signs of inferior myocardial scars. We exchanged the peripheral electrodes in a defined manner and investigated the resulting ECG for morphology and possible diagnostic errors. ⋯ The automatic ECG analyzer was not helpful in detecting artifacts by misplaced electrodes. A very low amplitude of the QRS complex in lead I, II, or III was pathognomonic for electrode misplacement in half of the cases. ECG artifacts must also be suspected when abnormal QRS- or P-axis occur or when QRS morphology does not match with the clinical presentation of the patient.
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Myocardial infarction (MI) infrequently results from nonatherosclerotic coronary diseases such as coronary embolism, spasm, dissection, and arteritis. If these disorders are not considered in the differential diagnosis of MI, specific beneficial therapies would be overlooked. Because physicians see large number of patients with MI during their career, the likelihood that they will encounter patients with MI resulting from nonatherosclerotic diseases is high. Two cases are presented to highlight different etiologies and treatment approaches of nonatherosclerotic MI.
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Recent literature on pediatric head injuries has suggested that important intracranial injuries might present to the ED without typical signs or symptoms. The objective of our study was to review our institutional experience with head-injured infants and young children to assess the subtlety of the ED presentation. We performed a retrospective medical record review of head-injured children