Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

The conventional machine algorithm interpreted this ECG as STEMI. See this post of RV MI with both McConnell sign and "D" sign: Inferior and Posterior STEMI. But the History in today's case was acute shortness of breath with dizziness and lightheadedness — and, essentially without chest pain!

Cardiogenic Shock 127

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 127

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. This is written by Willy Frick, an amazing cardiology fellow in St.

Plaque 127

Plaque Angina Blog Stents 127

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. The patient has a history of CABG so some of these changes could be old, but with ongoing chest pain and bradycardia in a high risk patient this is still acute OMI until proven otherwise. HR 40, BP 135/70, RR16, O2 100%.

Chest Pain 86

Chest Pain STEMI Bradycardia Myocardial Infarction 86

Dr. Smith's ECG Blog

MAY 13, 2017

He complained of severe chest pain and was extremely agitated, so much so that he was throwing chairs in triage. Technically, the STE meets STEMI criteria because there is greater than 2.5 These kinds of cases were excluded from the study as obvious anterior STEMI. JAMA Internal Med 2016 Dec 1.; What do you think?

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. A patient with OMI can have a totally normal ECG!"

Myocardial Infarction 123

Myocardial Infarction Chest Pain STEMI Blood Pressure 123

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 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

Dr. Smith's ECG Blog

OCTOBER 5, 2011

It turns out that this was a 27 yo African American male who presented with pressure-like (non-pleuritic) chest pain and dyspnea. Here is a case of a 45 year old with chest pain: There is ST elevation in inferior leads only, with no reciprocal ST depression in aVL. Would you be certain that it is not STEMI?

Chest Pain 52

Chest Pain STEMI Pericarditis Cardiac Arrest 52

BoardVitals - Cardiovascular

JANUARY 18, 2021

Other trials that evaluated this subject were the WOEST trial (2013), Pioneer AF-PCI trial (2016), and ISAR-TRIPLE (2015). ACS QID 3103 A 64 year old Caucasian male with a history of extensive tobacco use, hypertension, hyperlipidemia, and obesity presents with acute onset chest pain. Incorrect Answers: A and E. Question 2.

Bicuspid/Mitral 52

Bicuspid/Mitral Atrial Fibrillation Chest Pain STEMI 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Case An elderly patient had acute chest pain and 911 was called. Methods : The PERFECT study (#NCT02765477) is a retrospective, 16 center, international investigation of ED patients from 1/2008 - 12/2016 with VPR on the ECG and symptoms of acute coronary syndrome (ACS). What do you think? in leads with at least 1 mm STE.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. It was from a patient with chest pain: Note the obvious Brugada pattern. Bicarb 20, Lactate 4.2,

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

MAY 23, 2022

Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. Theres inferior STE which meets STEMI criteria, but this is in the context of tall R waves (18mm) and relatively small T waves, and the STD/TWI in aVL is concordant to the negative QRS. This was false positive STEMI with an ECG mimicking OMI.

Chest Pain 52

Chest Pain STEMI Pericarditis Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Case 1: 20-something woman with chest pain Case 2: 50-something man with chest pain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chest pain. They also recommended a NTG drip, after which she reported complete resolution of pain. She was a walk-in at triage.

Chest Pain 105

Chest Pain STEMI Aortic Ultrasound 105

Dr. Smith's ECG Blog

MARCH 17, 2025

Written by Willy Frick A man in his 60s with a history of hypertension and 40 pack-year history presented to the ER with 1 day of intermittent, burning substernal chest pain radiating into both arms as well as his back and jaw. In the world of STEMI, we are incapable of recognizing the first ECG as a false negative.

STEMI 81

STEMI Chest Pain Myocardial Infarction Document 81

Dr. Smith's ECG Blog

DECEMBER 5, 2019

The patient denied any chest pain whatsoever, and a troponin at zero and 2 hours were both undetectable. 2016) in the presence of spontaneous BrS ECG or drug-induced ECG. Heart Rhythm 2016. Types 2 and 3 have been merged into Type 2 and look substantially different. Is this Type 2 Brugada syndrome/ECG pattern?

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52