Asanka Migelheva

Emergency Physician special interest in Critical care, Retrieval Medicine and Toxicology #Traveller#FOAMED#Educator#Emergency physician#ECG#MD

[Asanka Migelheva @AMigelheva]

@Frances98392343 Yep it was flutter with 1.1 but the rate was around 250 ( mate be senior age leading to the lower rate than expected for a flutter)
Post Amiodarone revealed flutter waves

[Asanka Migelheva @AMigelheva]

82-year-old female, unwell with cough for ~1 week. While walking to the bus she became dizzy, pale, and sweaty.
ECG one given Amiodarone by the paramedics
ECG two on arrival

[Asanka Migelheva @AMigelheva]

26 year old pregnant lady 26 weeks of POA with severe epigastric pain
-Acute pancreatitis confirmed with lipase 6000+

ECG as below ( no ECGs to compare )
Thoughts

[Asanka Migelheva @AMigelheva]

35 year old male coming with intermittent sharp episodic chest pain for the last 3 days duration

Trop 1000— peaking to 4000
ECHO normal
Angio mild muscular bridge on LAD
What do you make of the ECG and presumptive Dx?

[Asanka Migelheva @AMigelheva]

@ElsevierHealth 2 months since ordering Cases in Pre-Hospital and Retrieval Medicine, 2e (20 Nov 2025, Order #0130053513). Followed up 1 month ago, but no update to date. I’d appreciate urgent escalation.#CustomerExperience

[Asanka Migelheva @AMigelheva]

Mobitz type 11 or complete heart block ?

[Asanka Migelheva @AMigelheva]

This patient had a Saddle PE needing urgent thrombolysis

Would suspect a PE looking at his ECG ?

[Asanka Migelheva @AMigelheva]

72 F
Acute onset chest pain
Value of serial ECGs (this change was over an hour )

Anything suspicious in the first ECG about what was coming?

[Asanka Migelheva @AMigelheva]

Culprits were LAD and D1

[Asanka Migelheva @AMigelheva]

Culprit artery/arteries ?

[Asanka Migelheva @AMigelheva]

@Elb3001 Any other artery ?

[Asanka Migelheva @AMigelheva]

We were thinking of AVRT as likelyDx , but his cardiologist had the impression to be Atrial flutter with 1.1

[Asanka Migelheva @AMigelheva]

15 year old boy, acute onset palpitation with marginal BPs

BG left Hypo-plastic heart heart syndrome with 4 reversion surgeries

[Asanka Migelheva @AMigelheva]

I would label this as an essentially normal
Looking EKG
He had a RV strain feature on bed side ECHO and CTPA confirmed a saddle PE which was thrombolysed

[Asanka Migelheva @AMigelheva]

This was a interesting case,
72 year old male recent CABG

12 hours history of progressive SOB with pleuritic type of chest pain

[Asanka Migelheva @AMigelheva]

CT Angio was normal , confirmed Takotsubo cardiomyopathy

[Asanka Migelheva @AMigelheva]

53 year old female presenting central crushing chest pain ,has been on going for 12 hours now

[Asanka Migelheva @AMigelheva]

Bed side ECHO was convincing for stress induced cardiomyopathy (Taskotsubo typical variation )
Waiting for coronary Angio will update with the results

[Asanka Migelheva @AMigelheva]

72 year old female complaining of progressive Shortness of breath for few days
What is your main concern with her ECG ?

[Asanka Migelheva @AMigelheva]

Presumptive Dx of WPW
Had a CT which showed
Evidence of calculus cholecystitis explaining his symptoms

[Asanka Migelheva @AMigelheva]

38 year old male coming with acute onset lower chest and epigastric pain for few hours
First Trop was negative at 1.5 hours