Case 1
A 57-year-old woman with a long-standing history of bronchial asthma and COPD was admitted because of intermittent episodes of dyspnea associated with palpitations and general weakness for five days.
選單
Introduction:
My medical journey began with the simple yet powerful electrocardiography (ECG) tool. Encountering it during my clerkship at National Taiwan University (1961-1968) sparked a fascination with its ability to diagnose and guide patient care. This fascination deepened through my residency at the University of Wisconsin (1970-1972) and cardiology fellowship at the University of Miami (1972-1974), where I built my foundation in internal medicine and cardiology, eventually specializing in clinical cardiac electrophysiology.
Despite advancements and new technologies, the ECG remains a cornerstone of the “five-finger approach” to patient evaluation, alongside history, physical exam, chest X-ray, and lab tests. While not without limitations, an ECG, interpreted in the context of a patient’s clinical presentation, often provides invaluable insights into conditions like myocardial ischemia/infarction, electrolyte imbalance, stroke risk, and even sudden death.
Dedication:
This section is dedicated to:
Invitation:
I invite you to explore these ECGs alongside their corresponding clinical settings. If you have questions or interesting ECG examples, please email me at [email protected].
Sincerely,
Ruey
A 57-year-old woman with a long-standing history of bronchial asthma and COPD was admitted because of intermittent episodes of dyspnea associated with palpitations and general weakness for five days.
A 58-year-old man, who had been in good health, became infuriated after a quarrel with his wife for 20 minutes. He suddenly experienced severe chest tightness with breathing difficulty and collapsed.
A 62-year-old man was brought to Emergency Department for severe chest tightness of sudden onset, lasting 30 min. He had experienced episodes of chest tightness unrelated to exertion for one year.
A 26-year-old Taiwanese man noted weakness in both lower legs and could not stand upon waking up. At the same time, he experienced upper back and arms pain and was brought to the Emergency Department (ED) in a wheelchair. There was no history of trauma, nor were there any signs of infection.
A 72-year-old woman, who had been in the hospital for treatment of right leg cellulitis for two days, suddenly developed increasing SOB with worsening heart failure (HF) 6 hours after a blood transfusion of 2 units packed cells for chronic anemia (Hb 7.8 mg%) (Chest X-ray 1 and Chest X-ray 2).
A 35-year-old woman with Marfan syndrome presented with increasing dyspnea, fever, productive cough, and chest tightness for one day.
It illustrates my thinking process when I look at the ECG during my initial workup of the patient. I hope you find it helpful in taking care of your patients.
It displays photographic images of art and the beauty of nature that resonate with positive thinking about life, encouraging medical students and young physicians never to give up pursuing their dreams.
It describes my uncharted academic career from becoming an internist, cardiologist, and clinical electrophysiologist to a medical educator in different stages before retirement.
If you have further questions or have interesting ECGs that you would like to share with us, please email me.
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