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

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

JULY 22, 2023

He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. Today's patient presented with acute weakness, syncope and fever, but no chest pain or shortness of breath.

Chest Pain 70

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 70

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 Ischemia Chest Pain Arrhythmia 52

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.

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Blog Arrhythmia Bradycardia Download 160

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

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 102

Coronary Angiogram Plaque Thrombosis STEMI 102

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

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

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

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 52

Tachycardia Pericarditis Ultrasound Blood Pressure 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

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