This patient’s ECG shows signs of myocardial contusion, including RBBB, and later, ST elevation, which are common findings, along with T wave changes. The initial ECG also showed some electrical alternans in V1-V3, thought to be the heart swinging in the large pneumothorax. Electrical alternans should raise concern for¬†pericardial effusion / tamponade. The patient’s initial troponin was 0.454 ng/mL and peaked at 2.824 ng/mL five hours later. Read more here¬†and read a scary case on Dr. Smith’s ECG Blog here

Initial ECG:


Day 2 ECG:


Day 3 ECG:


Day 4 ECG prior to discharge: