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2018 Chest Pain Myocardial Infarction 
Dr. Smith's ECG Blog
SEPTEMBER 26, 2023
2 middle aged males presented with chest pain. Which had the more severe chest pain at the time of the ECG? Patient 2 at the bottom with a very subtle OMI complained of 10/10 chest pain at the time the ECG was recorded. 414 patients were included in the analysis.
119 
Dr. Smith's ECG Blog
MAY 30, 2023
A 50-something man presented in shock with severe chest pain. Literature cited In inferior myocardial infarction, neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction Johanna E. The July 29, 2018 post ( LA-RA reversal ).
97 
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.
52 
Dr. Smith's ECG Blog
MARCH 27, 2023
(Unusual and puzzling, as there was a large focal acute MI) Final Diagnosis: Acute MI, Non ST Elevation Myocardial Infarction. The presence or absence of ST Elevation is a poor marker with which to describe a myocardial infarction. = NSTEMI is extremely heterogenous, from a very tiny Non-OMI to a massive OMI.
52 
Dr. Smith's ECG Blog
OCTOBER 24, 2019
[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." References Lobo AS et al. JACC 2019 Sep 10;74(10):1290-1300.
52 
Dr. Smith's ECG Blog
FEBRUARY 13, 2023
Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. Accuracy of OMI findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. Eur Heart J 2018 4. Who needs the cath lab? Int J Cardiol Heart Vasc 2021 2.
52 
Dr. Smith's ECG Blog
DECEMBER 27, 2023
Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.
131 
Dr. Smith's ECG Blog
JUNE 28, 2018
He had suffered a couple bouts of typical chest pain in the last 24 hours. This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. The pain had lasted about one hour. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction.
52 
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. Timing of revascularization in patients with transient ST segment elevation myocardial infarction: a randomized clinical trial. Eur Heart J 2018. A 70-something y.o. Lemkes et al. Full text link.
116 
Dr. Smith's ECG Blog
APRIL 18, 2024
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Echo showed new anterior regional wall motion abnormality and decrease EF from 60% to 45%. Clin Cardiol 2022 4.
121 
Dr. Smith's ECG Blog
NOVEMBER 5, 2023
By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. She's had multiple PCI procedures.
111 
Dr. Smith's ECG Blog
DECEMBER 19, 2018
A middle-aged woman had an acute onset of chest pain and dyspnea. The pain had almost resolved by the time an ECG was obtained in the ED: Here is the computer diagnosis What do you think? ng/ml , a three-fold increase from troponin #2, also confirming acute myocardial infarction. It was not normal!
52 
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. The ECG only tells you there is ischemia, not the etiology of it.
Dr. Smith's ECG Blog
NOVEMBER 24, 2018
Here it is: Computer Interpretation: SINUS RHYTHM INFERIOR MYOCARDIAL INFARCTION, POSSIBLY ACUTE ST ELEVATION, CONSIDER ANTERIOR INJURY [MARKED ST ELEVATION W/O NORMALLY INFLECTED T WAVE IN V2-V5] ACUTE MI What do you think? If it is a chest pain patient, I would get a formal echo and serial ECGs. And look for an old EKG."
52 
Dr. Smith's ECG Blog
OCTOBER 28, 2022
This is obviously diagnostic of inferior and lateral Occlusion Myocardial Infarction. The location of the infarct is clear, but that does not necessarily tell you what artery it is. Electrocardiographic diagnosis of acute coronary Occlusion Myocardial Infarction in ventricular paced rhythm using the modified Sgarbossa criteria.
52 
Dr. Smith's ECG Blog
JULY 31, 2020
The finding of dynamic ST-T wave changes on serial tracings in association with a change in chest pain symptoms ( SEE My Comment in the July 21, 2020 post ). Any ST elevation in inferior leads that occurs in association with mirror-image opposite ST depression in lead aVL. ST depression that is maximal in leads V2-to-V4.
52 
Dr. Smith's ECG Blog
JULY 31, 2018
This is diagnostic of myocardial infarction. In middle age women, it accounts for 22-35% of all ACS presentations 1,3 , and the reported incidence of ST-elevation myocardial infarction in this subset of patients is variable, but estimated to be between 24-50% 4. She felt more comfortable being admitted. Int J Cardiol.
52 
Dr. Smith's ECG Blog
JULY 11, 2018
A 40-something woman had sudden chest pain. But which myocardial walls are affected? Comment by KEN GRAUER, MD ( 7/11/2018 ): = Insightful blog post by Dr. Smith regarding ECG criteria for recognizing acute RV involvement in patients with inferior STEMI. She called 911. Figure-2: TOP — Initial ECG obtained pre-hospital.
52 
Dr. Smith's ECG Blog
NOVEMBER 3, 2017
Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 122(8):1303-1309. 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
52 
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. mm STE even in the fourth universal definition of myocardial infarction. Here are his publications.) What do you think ?
Dr. Smith's ECG Blog
FEBRUARY 15, 2018
She went on to describe her chest pain as a "buffalo sitting on my chest" and a "weird" sensation in her jaw for 1 hour prior to arrival, associated with lightheadedness and diaphoresis. The patient was given fentanyl initially for chest pain with minimal effect and then vomited which was followed by zofran and famotidine.
52 Dr. Smith's ECG Blog
OCTOBER 6, 2018
We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. The day prior to presentation (about 12 hours prior to presentation) he described sudden onset chest pain and shortness of breath while gardening in his back yard. He had no further pain and went to bed that night with no complaints.
40 
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. Am J Med 2019, 132(5):622-630. Miranda DF, Lobo AS, Walsh B, et al.
52 
Dr. Smith's ECG Blog
NOVEMBER 8, 2022
The patient had come to the ED for SOB, but without any chest pain. This was not a myocardial infarction of any kind. Other cases of Pulse Tapping Artifact: Acute chest pain and a bizarre ECG Bizarre (Hyperacute??) Therefore, as many as 11 of the 12 leads can look bizarre. He had a 10 pound weight loss.
52 
EMS 12-Lead
MAY 20, 2022
Cardiology felt her chest pain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Below are two examples of this.
Dr. Smith's ECG Blog
JULY 19, 2024
Written by Pendell Meyers, with edits by Smith A man in his 80s presented with acute chest pain and normal vital signs. We need more such ECGs for training but we are constantly working on the algorithm and one day it will make this diagnosis. == But isn't ongoing chest pain in NSTEMI a guideline indication for emergent angiography?
115 
DAIC
MAY 8, 2024
5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. 5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. For more information: www.heartflow.com References 1 Krievins, Dainis K.,
Dr. Smith's ECG Blog
MAY 8, 2023
Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Why is there this notion that myocardial infarction cannot be diagnosed in the setting of ventricular paced rhythm?
52 
Circulation: Cardiovascular Quality & Outcomes
FEBRUARY 3, 2025
BACKGROUND:The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) demonstrated that a precision diagnostic strategy reduced the primary composite of death, nonfatal myocardial infarction, or catheterization without obstructive coronary artery disease by 65% in patients with nonacute chest pain (..)
40 
Dr. Smith's ECG Blog
MAY 6, 2019
The patient presented with chest pain. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind.
52 
Dr. Paddy Barrett
JANUARY 30, 2024
MI = Myocardial Infarction/Heart Attack However, there are two very important caveats. 2023, 2 Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. 2018 Sep 6;379(10):924-933. So a very low chance. This was compared to using exercise stress testing. Journal of Cardiovascular Computed Tomography, Oct 9.
Coronary Artery Disease Journal
JULY 7, 2024
Background In myocardial infarction with nonobstructive coronary arteries (MINOCA), there are limited patient-level data on outcomes by sex and race. Methods Patients admitted to a single center with acute myocardial infarction (MI) between 1 January 2012 and 31 December 2018, were identified by chart and angiographic review.
DAIC
JANUARY 25, 2024
More than 8 million Americans visit hospital emergency departments experiencing chest pain every year. “In the future, patients with coronary inflammation can be identified by the CaRi-Heart technology and treated by our FDA -approved LODOCO 0.5 mg tablets.” In June 2023, the U.S.
110 
Dr. Smith's ECG Blog
SEPTEMBER 29, 2018
No chest pain. 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. Patients on dialysis often do not have chest pain in the setting of acute MI. Why is this?
52 
Heart BMJ
MAY 23, 2024
Background To determine if the European Society of Cardiology 0/1-hour (ESC 0/1-h) algorithm with high-sensitivity cardiac troponin T (hs-cTnT) meets the ≥99% negative predictive value (NPV) safety threshold for 30-day cardiac death or myocardial infarction (MI) in older, middle-aged and young subgroups.
52 
Dr. Smith's ECG Blog
OCTOBER 9, 2018
The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardial infarction. October 2018. We record ECGs in triage on every patient with chest pain, and some other indications, and this amounts to 8000 ECGs in triage each year, costing at most $200,000 (8000 x $20.00).
52 
Dr. Paddy Barrett
AUGUST 1, 2023
Share Chest Pain Symptoms There is no role for CT Calcium Scoring in the setting of someone with chest pain symptoms suspected to be from a narrowed coronary artery. Regardless, if you present with chest pain and get a stress test instead of a CTCA, you are arguably getting an inferior test. I would say yes.
Dr. Smith's ECG Blog
MARCH 6, 2019
A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath. Mechanical Reperfusion in Patients with Acute Myocardial Infarction Presenting More than 12 Hours from Symptom Onset: A Randomized Controlled Trial. mm STE in V1 and 1.5-2.0
52 
Dr. Smith's ECG Blog
OCTOBER 24, 2018
Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. First, the name (Myocardial Infarction or Not) is not important. A subsequent troponin drawn 6 hours after symptom onset , remained below the LoD.
40 
Dr. Smith's ECG Blog
OCTOBER 3, 2018
Case An elderly patient had acute chest pain and 911 was called. Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Here is our abstract from SAEM 2018. What do you think?
52 American College of Cardiology
FEBRUARY 1, 2025
Rachel Bond, MD, FACC, is the system director of the Women's Heart Health Program at Dignity Health in Arizona, which she founded in 2018. That's the only way we can give women a definitive diagnosis for what's causing their chest pain." Acute Myocardial Infarctions in Women. Can J Physiol. 2024;102:431-441.
Dr. Smith's ECG Blog
NOVEMBER 14, 2024
This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. Let's see how the PMCardio Queen of Hearts AI Model performs: "Acute Occlusive Myocardial Infarction" She gave this a score of 1.0 (100%
126 
Dr. Smith's ECG Blog
NOVEMBER 23, 2024
1) Very high initial troponin of 45,000 ng/L 2) A full day of chest pain 3) Q-waves on the ECG, with some T-wave inversion Here is one frame of the CT scan which includes the heart: Can you spot the infarct? The January 30, 2018 post — for PTA. This is then a large MI, but it is subacute. How do I know?
63 
Dr. Smith's ECG Blog
APRIL 9, 2025
A middle-age woman with no previous cardiac history called 911 for chest pain. Methods: Adult, non-traumatic OHCA patients in the ESO Data Collaborative 2018-2023 datasets who experienced OHCA prior to EMS arrival, presented with a shockable rhythm, and received amiodarone or lidocaine during resuscitation were evaluated for inclusion.
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