2019, Chest Pain and Coronary Artery Disease

Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A healthy 45-year-old female presented with chest pain, with normal vitals. The patient was previously healthy, with no atherosclerotic risk factors, and developed chest pain after an episode of stress. The pain was crushing retrosternal, radiated to the arms and was associated with lightheadedness.

Chest Pain

Chest Pain Pericarditis SCAD STEMI

A 20-something with intermittent then acute chest pain

Dr. Smith's ECG Blog

APRIL 25, 2023

Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. Cath lab activation by the ED and I agree with coronary angiography emergently." Result: no angiographically significant obstructive coronary artery disease. What do you think? Medical Rx.

Chest Pain

Chest Pain Pericarditis Blog Cardiomyopathy

Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score

Open Heart

AUGUST 25, 2024

Methods We prospectively included 1384 patients with LRHSs between March 2019 and March 2021. The primary endpoints included cardiac death, non-fatal myocardial infarction and unplanned coronary revascularisation. All the patients underwent NISI (involving myocardial perfusion imaging/stress echocardiography).

Chest Pain

Chest Pain Coronary Artery Disease Myocardial Infarction Electrocardiogram

A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

Chest Pain

Chest Pain Pulmonary ACE Inhibitor Pacemaker

The Advantages Of A CT Coronary Angiogram

Dr. Paddy Barrett

AUGUST 1, 2023

CT coronary angiography, in addition to a CT CAC, is arguably the best test for estimating whether someone has evidence of coronary artery disease and what that means for their near-term risk of a heart attack. This article is part 2 of a series on cardiac CT. I would say yes. For very good reason. And it matters.

Coronary Angiogram

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch).

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

India’s first post Covid 19 coronary bypass surgery patient discharged successfully.

Dr. Prateek Bhatnagar

SEPTEMBER 14, 2020

63 years old Afsar Khan resident of Karwan, Hyderabad had been having coronary artery disease and chest pain on exertion for about a year. In November 2019, he underwent CT coronary angiography which showed blocks in all 3 coronary arteries of the heart. He was still corona negative.

COVID-19

COVID-19 Chest Pain Pulmonary Coronary Artery Disease

Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

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.

Chest Pain

Chest Pain Ischemia Pacemaker Stent

The Evolving Computed Tomography Market

DAIC

MARCH 7, 2024

I think especially with the recent changes in guidelines and the recommendation to use CT for screening of coronary artery disease, we expect to see this trend really impact the way CT is used in the future.” “The CT procedural mix is evolving, and cardiac CT is starting to account for a large proportion of that.

Technology

Technology Document Cardiovascular Imaging Cancer

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain. A mid 60s woman with history of hypertension, hyperlipidemia, and GERD called 911 for chest pain. It is also NOT the clinical scenario of takotsubo (a week of intermittent chest pain).

Plaque

Plaque Chest Pain Thrombosis Stenosis

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. Incidence of an acute coronary occlusion. Am J Med 2019, 132(5):622-630. link] Harhash AA et al.

Ischemia

Ischemia STEMI Stenosis Chest Pain

An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) Not a STEMI: Reasons I did not think ECG #1 represented an acute STEMI — included the following: There was no history of chest pain. ng/mL and 0.10 ng/mL before returning to 0.05

STEMI

STEMI Document Blog Ischemia

External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis

Open Heart

DECEMBER 6, 2023

Objectives The risk factor-weighted and coronary artery calcium score-weighted clinical likelihood (RF-CL and CACS-CL, respectively) models improve discrimination of patients with suspected obstructive coronary artery disease (CAD). However, external validation is warranted.

Coronary Artery Disease

Coronary Artery Disease Chest Pain Myocardial Infarction Risk Factors

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

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

Coronary Angiogram Plaque Thrombosis STEMI

What are treatment options for this rhythm, when all else fails?

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. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

Stress Tests Are Useful But Not For The Reasons You Might Think

Dr. Paddy Barrett

SEPTEMBER 5, 2023

Share Let’s first state our goal when we are in the business of ‘Heart Disease Prevention’: To delay the onset of coronary artery disease (atherosclerosis/plaque) that might rupture and cause a heart attack. 2019 Sep 24;74(12):1582-1593. Not any more. Here’s why. J Am Coll Cardiol.

Plaque

Plaque Heart Attack Heart attacks Exercise

What will you do for this patient transferred to you who is now asymptomatic?

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. I believe this is by far the most common outcome for this patient around the world in 2019. European Heart Journal 2019. This is technically a STEMI, with 1.5

STEMI

STEMI Chest Pain Ischemia Myocardial Infarction

60-something with wide complex tachycardia: from where does the rhythm originate?

Dr. Smith's ECG Blog

APRIL 15, 2020

Angiogram: Severe coronary artery calcification Moderate to severe distal small vessel disease mainly seen in RPL1, 2 Otherwise, Mild plaque, no angiographically significant obstructive coronary artery disease. Figure-1: The 2 ECGs in this case ( See text ).

Tachycardia

Tachycardia Nursing Heart Disease Dysrhythmia

Cardiovascular Update

Healthy 45-year-old with chest pain: early repolarization, pericarditis or injury?

A 20-something with intermittent then acute chest pain

Use of downstream stress imaging tests for risk stratification of patients presenting to the emergency department with chest pain and low HEART score

A man in his 70s with chest pain during a bike ride

The Advantages Of A CT Coronary Angiogram

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

India’s first post Covid 19 coronary bypass surgery patient discharged successfully.

Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

The Evolving Computed Tomography Market

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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

An elderly male with acute altered mental status and huge ST Elevation

External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

What are treatment options for this rhythm, when all else fails?

Stress Tests Are Useful But Not For The Reasons You Might Think

What will you do for this patient transferred to you who is now asymptomatic?

60-something with wide complex tachycardia: from where does the rhythm originate?

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