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 123

Blog Chest Pain Cardiac Arrest Cardiomyopathy 123

Dr. Smith's ECG Blog

JUNE 17, 2016

There were no injuries and no chest pain and he appeared well. He complained of 3 days of diarrhea and abdominal pain. Pretest probability: Especially when there is no Chest pain, or there are very atypical symptoms, one should be very suspicious of the diagnosis of coronary occlusion unless the ECG is crystal clear.

STEMI 52

STEMI Chest Pain Hospital Blog 52

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m. 12:15 p.m.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Ken Grauer, MD

JANUARY 13, 2024

On the other hand — the ST elevation seen in lead V1 is perfectly consistent with LVH and LV "strain" ( ie, The shape of this ST-T wave in lead V1, in association with the deep S wave in this lead — is a mirror-image opposite picture of the typical expected appearance of LVH with "strain" in a lateral chest lead ).

Blog 159

Blog Ischemia AFIB Hypertension 159

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 52

Plaque Chest Pain Thrombosis Stenosis 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.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

JANUARY 31, 2020

The patient's chest pain had resolved by the time of the ECG 2. But it does prove that the patient has coronary disease and makes the probability that his chest pain is due to ACS very very high. He presents with an episode of brief, new-onset chest pain that had resolved by the time E CG # 1 was obtained.

Angina 52

Angina Stents Stent Aneurysm 52

Dr. Anish Koka

JANUARY 1, 2023

The diagnosis was made based on classic findings of inflammation on an electrocardiogram associated with acute chest pain. 2-3 days after this he developed the same sharp chest pain and shortness of breath with elevated inflammatory markers (CRP) as well as typical findings of pericarditis seen on ECG.

COVID-19 52

COVID-19 Pericarditis Chest Pain Biomarkers 52

Ken Grauer, MD

JULY 15, 2023

Subsequent testing supported the presumption of apical cardiomyopathy as the cause of this patient's sustained VT. ie, Severe subendocardial ischemia from sustained VT in a patient severe apical cardiomyopathy resulted in a peak troponin >31,000 ng/L in today's case ). CT coronary angiogram showed no obstructive coronary disease.

Blog 78

Blog Coronary Angiogram Cardiomyopathy Ischemia 78

Dr. Smith's ECG Blog

JANUARY 9, 2024

While fully acknowledging that "Sometimes ya gotta be there!" — in order to optimally assess the patient — the clinical definition of hemodynamic stability is for the patient to be without significant symptoms such as chest pain, shortness of breath, hypotension and/or mental status changes — as a direct result of the fast heart rate.

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

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. This is written by Willy Frick, an amazing cardiology fellow in St.

Plaque 127

Plaque Angina Blog Stents 127

Dr. Smith's ECG Blog

JUNE 20, 2020

He was admitted for monitoring, as his risk of a ventricular dysrhythmia as cause of the syncope is high ( very high due to HFrEF and ischemic cardiomyopathy ). He denied chest pain or dyspnea throughout. The estimated LV ejection fraction is 35%. No previous study for comparison.

STEMI 52

STEMI Hospital Coronary Angiogram Dysrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

Diagnosis : Extremely slow Atrial flutter == MY Comment , by K EN G RAUER, MD ( 11/15/2020 ): == Some of the most interesting ECG cases I have seen have been picked up “reading through a stack of ECGs” — in the same manner that Dr. Smith picked up today’s case. There was no chest pain — and all troponins were negative.

Atrial Flutter 52

Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

Instead, he complained of left chest "itchiness". He had a h/o ischemic cardiomyopathy and right MCA stroke. 9 Hours of Chest Pain and Deep Q-waves: Is it too late for Thrombolytics? Later, I obtained more clinical history. The patient initially presented with a report of SOB prehospital, but this he denied. LV Aneurysm?

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

AUGUST 8, 2020

As always, Takotsubo stress cardiomyopathy and focal myocarditis are rare possibilities which can only be proven after a negative cath. More to come. == MY Comment by K EN G RAUER, MD ( 8/8/2020 ): == I LIKE this case by Dr. Meyers — because of the subtle changes seen on serial tracings. What do you think?

Pericarditis 52

Pericarditis STEMI Chest Pain Arrhythmia 52

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 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Open Heart

APRIL 20, 2022

Objectives To describe a cohort of patients with arrhythmogenic left ventricular cardiomyopathy (ALVC), focusing on the spectrum of the clinical presentations. Methods Patients were retrospectively evaluated between January 2012 and June 2020. Of 47 tested patients, 29 (62%) were carriers of a pathogenic/likely pathogenic DNA variant.

Cardiomyopathy 52

Cardiomyopathy Chest Pain Sudden Cardiac Death Heart Failure 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. He denied headache or neck pain associated with exertion. Pattern consistent with Takotsubo's cardiomyopathy."

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. The granulomatous inflammation affects the heart, causing an infiltrative cardiomyopathy The most common manifestations of cardiac sarcoidosis are atrioventricular (AV) block and ventricular tachyarrhythmias (VT). This was written by Magnus Nossen The patient is a female in her 50s.

Tachycardia 107

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Smith's ECG Blog

OCTOBER 28, 2023

There was some dyspnea but no chest pain. 23/WCC — 2/21/2020 ). 23/WCC — 2/21/2020 ). 23/WCC — 2/21/2020 ). 23/WCC — 2/21/2020 ). A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. Here is his ECG. This shows LVH, with high voltage.

Preserved Ejection Fraction 57

Preserved Ejection Fraction Sudden Cardiac Death Heart Failure Chest Pain 57

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. The absence of any wall motion abnormality makes ischemic cardiomyopathy very unlikely. BP:143/99, Pulse 109, Temp 37.2 °C C (99 °F), Resp (!)

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain.

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

EMS 12-Lead

JUNE 1, 2022

Smith and Myers found that in otherwise classic Wellens syndrome – that is, prior anginal chest pain that resolves with subsequent dynamic T wave inversions on the ECG – even the T waves of LBBB behave similarly. [2] LBBB is typically the result of preexisting hypertrophy, ischemic heart disease, or cardiomyopathy. 5] Isnard, R.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Dr. Smith's ECG Blog

MARCH 6, 2025

With OMI, all you know is that your patient has some nonspecific chest pain, SOB, shoulder pain etc. So if the patient is stable, has good LV function on bedside echo, and is relatively young with no history of heart failure or cardiomyopathy, then posterior fascicular VT is likely. which is probably NOT due to acute MI.

Tachycardia 95

Tachycardia Dysrhythmia ICU Pulmonary 95