2020, Cardiac Arrest and Chest Pain - Cardiovascular Update

Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Do either, both, or neither have occlusion MI? Vitals were normal.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

What do you suspect from this ECG in this 40-something with SOB and Chest pain?

Dr. Smith's ECG Blog

JANUARY 8, 2024

Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization): The patient is 40 years old and presented to another hospital with chest pain and SOB. She had been sitting doing work when she experienced "waves of chest tightness". Sats were 88%.

Chest Pain

Chest Pain Pulmonary Embolism STEMI

Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

JUNE 5, 2024

The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder.

Chest Pain

Chest Pain Blog Cardiac Arrest Cardiomyopathy

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. So, your next step is to Trace it down, and Copy it over".

Cardiac Arrest

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter

75 year old dialysis patient with nausea, vomiting and lightheadedness

Dr. Smith's ECG Blog

AUGUST 19, 2023

Because the patient had no chest pain or shortness of breath, they were initially diagnosed as gastroenteritis. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. Potassium was normal. Cardiology did not think it was "STEMI", but repeated the troponin. Take home 1.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. A recent similar case: A 40-something with chest pain. Is this inferior MI?

Cardiac Arrest

Cardiac Arrest Defibrillator Ischemia Tachycardia

ECG Blog #434 — WHY Did this Patient Arrest?

Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. C ASE C onclusion: As noted above — the middle-aged man in today's case presented to the ED in cardiac arrest. In view of this history — How would YOU interpret the ECG in Figure-1 ?

Blog

Blog STEMI Cardiac Arrest Tachycardia

Proportionality is a major element in the ECG Diagnosis of OMI.

Dr. Smith's ECG Blog

DECEMBER 13, 2023

This middle aged patient presented with chest pain: What do you think? As review — I've copied the Table in Figure-2 from previous discussions of potential causes of Low Voltage ( See My Comment in the October 15, 2023 — the November 12, 2020 — and the January 24, 2020 posts in Dr. Smith's ECG Blog ).

Blog

Blog Chest Pain Cardiac Arrest Cardiomyopathy

ECG Blog #400 — Is this a NSTEMI?

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). Having looked for negative U waves in patients with chest pain over a period of decades — I'll emphasize that this is not a common finding.

Blog

Blog Chest Pain Ischemia STEMI

Computer and transferring physician say "normal." What do you think?

Dr. Smith's ECG Blog

AUGUST 1, 2020

He has done a lot of great work on cardiac arrest, including as co-author of our study on esmolol in refractory cardiac arrest, and much more with Keith Lurie. A 40-something woman was in a remote alpine location when she complained of crushing chest pain. See his Google Scholar profile here.

Chest Pain

Chest Pain STEMI Cardiac Arrest Ischemia

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

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Series of Prehospital ECGs Showing Reperfusion == MY Comment by K EN G RAUER, MD ( 9/21/2020 ): == I wish those cardiologists who continue to strictly adhere to STEMI millimeter criteria would begin reading Dr. Smith’s ECG Blog. A mysterious case.

STEMI

STEMI Hospital Blog Defibrillator

Fascinating case of dynamic shark fin morphology - what is going on?

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

Ischemia

Ischemia Arrhythmia Defibrillator Chest Pain

A woman in her 20s with syncope

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? Figure-2: Causes of Low Voltage on ECG ( Figure reproduced from My Comment at the bottom of the page in the November 12, 2020 post in Dr. Smith's ECG Blog ). What is ELECTRICAL ALTERNANS?

Tachycardia

Tachycardia Pericarditis Ultrasound Blood Pressure

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med [Internet] 2019;Available from: [link] Should all patients with shockable arrest be taken to angiography regardless of STEMI or No STEMI?

Defibrillator

Defibrillator Cardiac Arrest STEMI 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 history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

A Middle-Aged male with Chest Pain and an Unusual ECG

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. Is it Brugada pattern?

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

Sudden shock with a Nasty looking ECG. What is it?

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain?

Cardiogenic Shock

Cardiogenic Shock Cardiac Arrest Hospital Ischemia

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This is a case written by Dan Lee (One of our fantastic Hennepin Residents, class of 2020 ) edits by Smith A 60 something-year-old man with a history of ESRD, LVH and prior CABG presented after an episode of hypotension during his hemodialysis, run followed by a syncopal episode which caused his run to be terminated early. No chest pain.

Chest Pain

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Other cases of LAD OMI with RBBB/LAFB: A man in his 40s who really needs you to understand his ECG Cardiac Arrest at the airport, with an easy but important ECG for everyone to recognize A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia Ventricular Fibrillation, ROSC after perfusion restored by ECMO, then ECG.

Chest Pain

Chest Pain Cardiogenic Shock Tachycardia Ischemia

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

ECG Blog #383 — Is this Coronary Disease?

Ken Grauer, MD

JUNE 6, 2023

Unfortunately — the patient abruptly developed hypoxemia, followed by cardiac arrest with PEA. It was thought that this action precipitated the patient's desaturation, and led to his cardiac arrest. The plan was to proceed as soon as possible with aortic valve replacement. He could not be resuscitated.

Blog

Blog Pulmonary Hypertension Aortic

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. They recommended repeating his ECG and awaiting troponin since the patient did not have any chest pain. Steve, what do you think of this ECG in this Cardiac Arrest Patient?" What is it?

Chest Pain

Chest Pain Bradycardia Cardiac Arrest STEMI

Cardiologist declines taking patient to the cath lab. Patient dies.

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain. Here is his first ED ECG: What do you see?

Chest Pain

Chest Pain STEMI Blog Tachycardia

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. The elevated troponin was attributed to either type 2 MI or to non-MI acute myocardial injury. There is no further workup at this time. Smith: Here is a case that was just texted to me today from a former resident. This patient ruled out for MI.

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Chest pain, among other symptoms. What do you see?

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. Comment by K EN G RAUER, MD ( 2/11 /2023 ): = Today’s case is from a patient with “many complaints”, including chest pain — and, an ECG that raised concern about acute anterior OMI. Chest pain was just one of these complaints. The ioninzed calcium was 6.5

Chest Pain

Chest Pain Cardiac Arrest STEMI Arrhythmia

Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Smith comment: The patient was lucky to have a cardiac arrest. By undergoing an arrest, providers became aware of his OMI which had not been noticed on his diagnostic ECG, and he thus has a chance at some myocardial salvage.

Cardiac Arrest

Cardiac Arrest STEMI Blog Ischemia

One of those ECGs you need to instantly recognize, which learners may struggle with at first

Dr. Smith's ECG Blog

JANUARY 11, 2025

Written by Pendell Meyers An adult man presented with acute chest pain. Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin. What is the Diagnosis in this 70-something with Chest Pain? 68 minutes with chest compressions, full recovery. To quote Drs.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest

Two patients with chest pain and RBBB: do either have occlusion MI?

What do you suspect from this ECG in this 40-something with SOB and Chest pain?

Normal angiogram one week prior. Must be myocarditis then?

Webinars

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

75 year old dialysis patient with nausea, vomiting and lightheadedness

Cardiac Arrest. What does the ECG show? Also see the bizarre Bigeminy.

ECG Blog #434 — WHY Did this Patient Arrest?

Proportionality is a major element in the ECG Diagnosis of OMI.

ECG Blog #400 — Is this a NSTEMI?

Computer and transferring physician say "normal." What do you think?

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

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Fascinating case of dynamic shark fin morphology - what is going on?

A woman in her 20s with syncope

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

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

A Middle-Aged male with Chest Pain and an Unusual ECG

Sudden shock with a Nasty looking ECG. What is it?

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

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

ECG Blog #383 — Is this Coronary Disease?

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Cardiologist declines taking patient to the cath lab. Patient dies.

Hyperthermia and ST Elevation

Chest pain, among other symptoms. What do you see?

Sometimes a patient is fortunate to have a cardiac arrest

One of those ECGs you need to instantly recognize, which learners may struggle with at first

Stay Connected