Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Ken Grauer, MD

OCTOBER 13, 2023

She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. As a result — IF no "fixable" cause is found ( ie, ischemia/infarction — electrolyte disturbance — rate-slowing medication ) — then because of the AV block and very slow heart rate, this patient will probably need a pacemaker.

Blog 158

Blog Arrhythmia Bradycardia Download 158

Ken Grauer, MD

JULY 22, 2023

Although this " Imbalance " of precordial T waves is not see n very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) , most often from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

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Blog Chest Pain STEMI AFIB 78

Dr. Smith's ECG Blog

JUNE 1, 2022

A 40-something male with no previous cardiac disease presented with chest pain. Here is his ECG: There is no clear evidence of OMI or ischemia. This is suspicious for inferior reciprocal At this point, with continued pain, cath lab activation is indicated. even in the absence of ECG findings.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Bradycardia 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. Anything more on history? J Electrocardiol 2013;46:240-8 2.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 22, 2022

There is no ischemia, certainly no concern at all for OMI. P.S.: Note that in today's case — the brief description of the chest pain history in this teenager does not sound convincing for an acute cardiac event. I see maybe one of these ECGs each month in my practice.

Blog 52

Blog Chest Pain Ischemia Arrhythmia 52

Ken Grauer, MD

APRIL 29, 2023

The overall ST-T wave appearance in this lead looks more like LV “strain” than ischemia. Ideally obtain a stat Echo at the bedside ( which if this shows a regional wall motion abnormality during chest pain — would confirm an acute evolving event ). ECG Blog #350 — regarding T Wave Imbalance in the Chest Leads.

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Blog Chest Pain STEMI Ischemia 78

Dr. Smith's ECG Blog

MAY 5, 2022

He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. They recommended repeating his ECG and awaiting troponin since the patient did not have any chest pain. He complained of generalized weakness and left lower extremity numbness. What is it?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Written by Pendell Meyers, few edits by Smith A man in his 60s with history of stroke and hypertension but no known heart disease presented with chest pain that started on the morning of presentation at around 8am. Here is his triage ECG when he presented at 1657: What do you think? It is posterior OMI until proven otherwise.

STEMI 52

STEMI Chest Pain Myocardial Infarction Document 52

Ken Grauer, MD

OCTOBER 27, 2023

This suggests ischemia of uncertain duration. Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT th e AV Blocks are — and what they are not ! There is deep, symmetric T wave inversion with a prolonged QTc interval in anterior leads V1,V2,V3.

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Blog Pacemaker Bradycardia Arrhythmia 103

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

Ischemic ST-segment depression maximal in V1-V4 (versus V5-V6) of any amplitude is specific for Occlusion Myocardial Infarction (versus nonocclusive ischemia). Arch Cardiovasc Dis 2013 Khan AR et al. Smith : this proves my impression that the inferior T-waves on the first ECG are hyperacute. JAHA 2022 Grosmaitre P et al.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? 2013 Sep;26(9):965-1012.e15. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. J Am Soc Echocardiogr. doi: 10.1016/j.echo.2013.06.023.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

JANUARY 9, 2025

A 26 year old male presented with syncope and chest pain. No signs of OMI" The chest pain resolved after some time, and another ECG was recorded: The ST Elevation is nearly gone. Doesn't this necessarily mean that he was having ischemia? This appears to be an inferior OMI What do you think?

Chest Pain 106

Chest Pain Ischemia Dysrhythmia Arrhythmia 106

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. Denying patients the potential benefit of revascularization just because their symptoms have lasted a certain amount of time shows poor understanding of the pathophysiology of myocardial ischemia. He presented to the emergency department for evaluation.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Ken Grauer, MD

MARCH 8, 2025

The ECG in Figure-1 was obtained from a middle-aged man who presents to the ED ( E mergency D epartment ) with 6 hours of chest pain. Figure-1: The initial ECG in today's case obtained from a middle-aged man with 6 hours of chest pain. ( He is hemodynamically stable. ECG Blog #228 Reviews the concept of " Silent " MI.

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Blog STEMI Download Chest Pain 106

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. SanzRuiz, R.,

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75