Dr. Smith's ECG Blog

JANUARY 1, 2024

Although the patient reported experiencing mild pressure-like chest pain, there was suspicion among clinicians that this might be indicative of an older change. The patient rapidly regained consciousness, reporting no residual pain. There is some ST-segment elevation in DII, DIII, aVF, V4-6.

Tachycardia 112

Tachycardia Blog Ischemia Heart Failure 112

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. There is no definite evidence of acute ischemia. (ie, The below ECG was recorded.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

J Electrocardiology 50(5):561-569; September/October 2017. This is the initial ED ECG of a 46 year old male with chest pain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 ng/ml) A 45 year old male called 911 for chest pain: The QTc was 400 ST Elevation at 60 ms after the J-point in lead V3 = 3.5

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Case An elderly patient had acute chest pain and 911 was called. European Heart Journal 38(41):3082-3089; November 1, 2017. And, in cases like the elderly patient with new-onset chest pain presented here — definitive diagnosis of acute STEMI is sometimes deceptively easy. What do you think?

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He was asked multiple times about chest pain or dyspnea, but repeatedly denied any such symptoms. Patient denied chest pain on initial review of symptoms. Was now endorsing chest pain which began 30 minutes ago. Upon further questioning, he states that he has had intermittent chest pain since yesterday.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

Dr. Paddy Barrett

DECEMBER 5, 2023

Whether stenting a narrowed coronary artery improves symptoms such as chest pain (angina) or shortness of breath is a very different question. Subscribe now 1 ISCHEMIA Research Group. However, the devil is in the detail when considering this question, and I have discussed it in more detail here. What About Symptoms?

Stents 59

Stents Stent Angina Heart Attack 59

EMS 12-Lead

MAY 20, 2022

There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This is the initial ECG: The QRS is widened with a regular cadence, and there are no discernable P waves.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

DECEMBER 27, 2018

JACC 69(23):1694-1703; April 4, 2017. But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. All bets would be off if instead of no chest pain, this patient had worrisome new-onset symptoms. Nevertheless, it has the look of LVH. Peguero JG et al.

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. For now, the 2017 AHA/ACC/HRS guidelines for asymptomatic patients that have inducible types of Brugada syndrome recommend observation without any specific therapies or interventions [8]. There is no further workup at this time.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. Lead V2 shows RR’ QRS configuration, and although ST depression is otherwise expected here, the discordance is a bit excessive. 2] Meyers, H.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 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). Eur Heart J 2017 Driver BE, Shroff GR, Smith SW. 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? 2017 Nov;35(4):525-537. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. J Am Soc Echocardiogr. 2013 Sep;26(9):965-1012.e15. 2013.06.023.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

AUGUST 10, 2023

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The pain improved (6/10) but is persisting, which prompted him to visit the Emergency Department. What do you think?

Chest Pain 98

Chest Pain STEMI Ischemia Nursing 98

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Evidence of acute ischemia (may be subtle) vii. Left BBB vi. Pathologic Q-waves viii.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

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

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

Chest Pain 63

Chest Pain Ischemia Plaque Stents 63