2018, Chest Pain and Echocardiogram - Cardiovascular Update

Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

Chest Pain

Chest Pain Blog Critical Care Arrhythmia

Chest Pain and Inferior ST Elevation.

Dr. Smith's ECG Blog

JUNE 17, 2018

A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. Inclusion criteria were chest pain, at least 2 serial cTnI in 24 hours, sinus rhythm , and at least 1 ECG.

Chest Pain

Chest Pain Pericarditis Tachycardia Myocardial Infarction

What do you think the echocardiogram shows in this case?

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. EMS gave 324 mg aspirin and 3 sublingual NTG, which the patient stated reduced the substernal chest pain from an 8/10 to 4/10. Pain better still. What do you think the echocardiogram shows? NTG drip started.

Echocardiogram

Echocardiogram Ischemia Chest Pain Blog

An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. Eur Heart J 2018. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free).

Chest Pain

Chest Pain Myocardial Infarction STEMI Critical Care

A Patient with Vertigo

Dr. Smith's ECG Blog

JULY 26, 2023

5 years ago Similar Previous formal echocardiogram Inferior posterior with dyskinesis "Dyskinesis" is the technical echo term for LV aneurysm. The combination of absence of chest pain and history of LV aneurysm made it easy to assess that this patient does not have acute OMI. The patient ruled out by serial troponins.

Aneurysm

Aneurysm Chest Pain STEMI Bradycardia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Hopefully a repeat echocardiogram will be performed outpatient. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. 1900: RBBB and LAFB are almost fully resolved.

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

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. See this case: what do you think the echocardiogram shows in this case? Miranda DF, Lobo AS, Walsh B, et al.

Ischemia

Ischemia STEMI Stenosis Coronary Artery Disease

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

No chest pain. I think a good start would be a posterior EKG and a high quality contrast echocardiogram read by an expert. His inpatient clinicians did not think that an urgent angiogram was warranted given that he was chest pain free, his EKG appeared nondiagnostic, and serial troponins were not elevating beyond 2 ug/L.

Chest Pain

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia

An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

JULY 31, 2018

These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. See this post: Classic Evolution of Wellens' T-waves over 26 hours This is one patient, with ECG recorded at time zero after pain resolution, then at time 2 hours, then at time 9 hours. 111.966630.

SCAD

SCAD Chest Pain Myocardial Infarction Ischemia

Syncope and Prehospital Cath Lab activation -- What do you think?

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

male with a history of HTN and ETOH developed squeezing epigastric abdominal pain with associated vomiting and diaphoresis, followed by a syncopal episode which lasted about 10 seconds. When medics arrived, he denied any chest pain, shortness of breath, or palpitations prior to the syncopal episode.

Chest Pain

Chest Pain Ischemia Angina Electrocardiogram

A man in his 70s with weakness and syncope

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. Formal echocardiogram showed normal EF, no wall motion abnormalities, no pericardial effusion.

Chest Pain

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia

ECG Blog #412 — Is Cardiac Cath Indicated?

Ken Grauer, MD

JANUARY 13, 2024

On the other hand — the ST elevation seen in lead V1 is perfectly consistent with LVH and LV "strain" ( ie, The shape of this ST-T wave in lead V1, in association with the deep S wave in this lead — is a mirror-image opposite picture of the typical expected appearance of LVH with "strain" in a lateral chest lead ).

Blog

Blog Ischemia AFIB Hypertension

A young patient with diminishing pain with a subtle but diagnostic ECG.

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Case A 39-year-old male without prior medical history presents with chest pain that started 2 hours prior to presentation. He says that the pain intensity was 10/10 at home but now about 4/10. Despite the clinical stability and decreasing pain, this patient needs an immediate angiogram. Here are his publications.)

Myocardial Infarction

Myocardial Infarction Chest Pain Blog Echocardiogram

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD. It was from a patient with chest pain: Note the obvious Brugada pattern. The Troponin I was cycled over time and was 0.353 followed by 0.296. This patient ruled out for MI.

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

The pneumothorax was expanded with a chest tube At 17 hours, another ECG was recorded: It is now much less dramatic and has the morphology of Type 2 Brugada The hs troponin I peaked at 6500 ng/L -- this strongly suggests myocardial contusion. An echocardiogram was done. Is there also Brugada? Right ventricular prominence.

Arrhythmia

Arrhythmia Blog Chest Pain Cardiac Arrest

Noisy, low amplitude ECG in a patient with chest pain

Chest Pain and Inferior ST Elevation.

What do you think the echocardiogram shows in this case?

An elderly male with shortness of breath

A Patient with Vertigo

A teenager involved in a motor vehicle collision with abnormal ECG

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

An athletic 30-something woman with acute substernal chest pressure

Syncope and Prehospital Cath Lab activation -- What do you think?

A man in his 70s with weakness and syncope

ECG Blog #412 — Is Cardiac Cath Indicated?

A young patient with diminishing pain with a subtle but diagnostic ECG.

Hyperthermia and ST Elevation

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

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