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.

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Dr. Smith's ECG Blog

APRIL 22, 2022

Written by Jesse McLaren, with comments from Smith and Grauer A 60 year old presented with three weeks of intermittent non-exertional chest pain without associated symptoms. A prospective validation of the HEART score for chest pain patients at the emergency department. JAMA Intern Med 2019 9. Int J Cardiol 2013 2.

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Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

DECEMBER 16, 2019

A 50-something male who is healthy and active with no previous medical history presented with 5 hours of continuous worrisome chest pain. Chest pain with New LBBB: It helps to actually measure the ST/S ratio A Fascinating Demonstration of ST/S Ratio in LBBB and Resolving LAD Ischemia The cath lab was activated.

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Open Heart

AUGUST 25, 2024

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

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Dr. Smith's ECG Blog

MAY 19, 2022

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. His symptoms of chest pain and shortness of breath were attributed to an asthma exacerbation during exercise.

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Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

== MY Comment by K EN G RAUER, MD ( 9/17/2020 ): == Todays patient is a previously healthy, 60-something year-old woman who presented with chest pain that began at a reception. We are indebted to Dr. Smith for developing Modified Smith-Sgarbossa Criteria for assessing ST-T wave changes in chest pain patients with LBBB.

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Chest Pain STEMI Blog Myocardial Infarction 52

All About Cardiovascular System and Disorders

APRIL 15, 2024

The main heart attack symptoms assessed by the study were: Chest pain or discomfort Shortness of breath Pain or discomfort in arms or shoulders Feeling weak, lightheaded, or faint Jaw, neck, or back pain Reference Mahajan S, Valero-Elizondo J, Khera R, Desai NR, Blankstein R, Blaha MJ, Virani SS, Kash BA, Zoghbi WA, Krumholz HM, Nasir K.

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Heart attacks Heart Attack Chest Pain Myocardial Infarction 52

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.

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Chest Pain Pacemaker Ischemia Stents 111

The British Journal of Cardiology

JUNE 11, 2024

Cardiovascular diseases (CVDs) have been reported to occur in a significant number of patients diagnosed with coronavirus disease 2019 (COVID-19). Additionally, 2D transthoracic echocardiography (TTE), and myocardial injury serum biomarkers assays (creatine phosphokinase-MB [CPK-MB] and cardiac troponins [cTn]) were measured once.

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Open Heart

JANUARY 30, 2024

Background Patients who experience in-hospital ST-segment elevation myocardial infarction (iSTEMI) represent a uniquely high-risk cohort owing to delays in diagnosis, prolonged time to reperfusion and increased mortality. Quality initiatives aimed at improving the care of this vulnerable, yet understudied population are needed.

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Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 8, 2024

However, data on whether a high-sensitivity HEART Pathway (hs-HP) are safe and effective is lacking.METHODS:An interrupted time series study was conducted at 5 North Carolina sites in 26 126 adult emergency department patients being investigated for possible acute coronary syndrome and without ST-segment–elevation myocardial infarction.

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Myocardial Infarction Chest Pain Electrocardiogram Risk Factors 40

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.

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Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

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.

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Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

JANUARY 3, 2022

This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chest pain. It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain.

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STEMI Myocardial Infarction Chest Pain Ischemia 52

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. This ECG was recorded on arrival: What do you think? mm STE in V1 and 1.5-2.0

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STEMI Chest Pain Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. The ECG in ER is shown below: ECG is still diagnostic but we are watching the natural course of myocardial infarction here.

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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.

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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.

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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.

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Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. Not a STEMI: Reasons I did not think ECG #1 represented an acute STEMI — included the following: There was no history of chest pain. J Electrocardiol. 2017 Sep-Oct;50(5):561-569. doi: 10.1016/j.jelectrocard.2017.04.005.

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STEMI Document Blog Ischemia 116

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

MARCH 11, 2019

Cardiac Troponin Changes to Distinguish Type 1 and Type 2 Myocardial Infarction and 180-Day Mortality Risk. At some point he returned with chest pain, and all these findings were put into place. Many MI do not have chest pain 4. The most common “non-chest-pain-equivalent” symptom is shortness of breath.

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Chest Pain Ischemia Aneurysm Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 31, 2020

Terminal QRS distortion ( ie, the absence of both a J-wave and an S-wave in either lead V2 or lead V3 ) — SEE My Comment in the November 14, 2019 post for an illustration and description of T-QRS-D. The more leads in a given lead area that show hyperacute changes — the greater the concern for acute OMI.

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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.": I do not think this is acute occlusion myocardial infarction (OMI). This history of a week of constant chest pain is also much more suggestive of myocarditis.

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Chest Pain Myocardial Infarction Pericarditis Angina 52

Dr. Smith's ECG Blog

MAY 2, 2019

Written by Pendell Meyers I received this prehospital ECG (we receive prehospital ECGs by telemetry from EMS in a large area around our hospital) and was told that there was a patient in her 50s with chest pain who was headed to an outside hospital (which happens to be a catheterization center).

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STEMI Hospital Chest Pain Myocardial Infarction 52

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. V5-V6) of any amplitude, is specific for Occlusion Myocardial Infarction (vs. The patient was very agitated and could not hold still. Meyers, Bracey, Smith, et al.

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Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Written by Pendell Meyers, few edits by Smith A man in his 60s with history of stroke and hypertension but no known heart disease presented with chest pain that started on the morning of presentation at around 8am. Here is his triage ECG when he presented at 1657: What do you think?

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STEMI Chest Pain Myocardial Infarction Document 52

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. Am J Med 2019, 132(5):622-630. American Journal of Medicine 132(5):622-630; May 2019.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

A 40 something otherwise healthy man presented with substernal chest pain. We wrote this Editorial in the Journal of Electrocardiology in 2019. To amplify remarks by Dr. Smith above — considering the clinical context (ie, new-onset substernal chest pain ) — no less than 9/12 leads in ECG #1 are clearly abnormal.

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Chest Pain STEMI Article Myocardial Infarction 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.

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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. Appearance of Abnormal Q Waves Early in the Course of Acute Myocardial Infarction: Implications for Efficacy of Thrombolytic Therapy.”

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STEMI Chest Pain Ischemia Aneurysm 40

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. The patient has a history of CABG so some of these changes could be old, but with ongoing chest pain and bradycardia in a high risk patient this is still acute OMI until proven otherwise. Eur Heart J 2019 5.

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Dr. Smith's ECG Blog

JANUARY 17, 2024

Written by Jesse McLaren Two patients presented with acute chest pain, and below are the precordial leads V1-6 for each. Hyperacute T waves can be a useful sign of occlusion myocardial infarction if appropriately defined. Acad Emerg Med 2023 3. Smith, Meyers. Ann Emerg Med 2023 4. Meyers, Bracey et al.

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Open Heart

DECEMBER 6, 2023

Compared to the 2019 European Society of Cardiology pretest probability (ESC-PTP) model, the aims were (1) to validate the RF-CL and CACS-CL models for identification of obstructive CAD and revascularisation, and (2) to investigate prognosis by CL thresholds. The endpoint was non-fatal myocardial infarction or cardiovascular death.

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Coronary Artery Disease Chest Pain Myocardial Infarction Risk Factors 52

Dr. Smith's ECG Blog

JANUARY 23, 2025

Case A 76 year old man with chronic hypertension but no history of coronary disease or myocardial infarction presented to the ED with chest pain at 2343. We've reviewed illustrative cases on this subject often ( See My Comment in the September 17, 2020 post and the April 7, 2019 post , among others ).

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Dr. Smith's ECG Blog

MARCH 8, 2025

He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. The authors describe a case with some features in common with our patient -- a stressful event followed by a stress cardiomyopathy/acute myocardial infarction overlap syndrome. SanzRuiz, R., Solis, J., & link] Bai, J.,

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75

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 September 22, 2019 post — intermittent ST-T wave artifact. The August 26, 2019 post — baseline artifact.

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