Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms.

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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. His echocardiogram showed normal wall motion.

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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. A rapid echocardiogram was performed, revealing an ejection fraction of 20% with thinning of the anterior-apical walls.

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Dr. Smith's ECG Blog

OCTOBER 12, 2024

Echocardiogram was obtained and showed mild LVH without regional wall motion abnormality. Not a STEMI: Reasons I did not think ECG #1 represented an acute STEMI — included the following: There was no history of chest pain. Following PCI, the patient ruled out by troponins : troponin increased to 0.08 ng/mL and 0.10

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Dr. Smith's ECG Blog

JULY 21, 2019

They were recorded 12 minutes apart: "Hey Steve, 30-something with one week of chest pain, mostly right-sided, better with sitting up.": Get an emergent contrast echocardiogram. This history of a week of constant chest pain is also much more suggestive of myocarditis. What do you think? flat ST segment in V4 2.

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Dr. Smith's ECG Blog

SEPTEMBER 21, 2022

A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. Echocardiogram: The estimated left ventricular ejection fraction is 34% Regional wall motion abnormality-lateral, akinetic. A massive acute OMI.

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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).

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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? Am J Med 2019, 132(5):622-630.

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Dr. Smith's ECG Blog

FEBRUARY 4, 2022

A 40 something otherwise healthy man presented with substernal chest pain. Formal Echocardiogram: The estimated left ventricular ejection fraction is 58 %. We wrote this Editorial in the Journal of Electrocardiology in 2019. It had occurred once 3 days prior and resolved without any medical visit. What do you think?

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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.

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Dr. Smith's ECG Blog

APRIL 15, 2020

Echocardiogram: Estimated left ventricular ejection fraction, lower limits of normal; 45-50%. M Y T HOUGHTS : I have previously reviewed my Systematic Approach to Rhythm Interpretation ( See My Comment in the October 16, 2019 post ). Tele Monitor: Normal sinus rhythm throughout, no ectopic atrial or ventricular beats.

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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.

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Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. Later, he underwent a formal echocardiogram: Very severe left ventricular enlargement (LVED diameter 7.4 BP:143/99, Pulse 109, Temp 37.2 °C

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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.

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Dr. Smith's ECG Blog

APRIL 3, 2019

History : An extremely elderly patient who lived independently presented with acute "oppressive" chest pain 7/10 in severity that was not positional, pleuritic, or reproducible. That is a reasonable thought, but we have shown that if there is one lead of V1-V4 with a T/QRS ratio greater than 0.36, then it is STEMI, not LV aneurysm.

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Dr. Smith's ECG Blog

FEBRUARY 16, 2025

This is a very bold statement in a type 1 diabetic with very concerning sounding chest pain. The patient was treated with aspirin and a GI cocktail, which did not help the pain. Echocardiogram was finally performed five hours after the first diagnostic ECG. Echocardiogram showed LVEF 33% with akinesis of the lateral wall.

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