2020, Chest Pain and Embolism - 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. Ten days later the patient returned with worsening pleuritic chest.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Dr. Smith's ECG Blog

MAY 23, 2023

Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset.

Chest Pain

Chest Pain STEMI Blog Stents

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

Dr. Smith's ECG Blog

JANUARY 8, 2024

Smith interpretation: This is highly likely to be due to extreme right heart strain and is nearly diagnostic of pulmonary embolism. She had been sitting doing work when she experienced "waves of chest tightness". She had been sitting doing work when she experienced "waves of chest tightness". It is of course pulmonary embolism.

Chest Pain

Chest Pain Pulmonary Embolism STEMI

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Noisy, low amplitude ECG in a patient with chest pain

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.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

What does the ECG show in this patient with chest pain, hypotension, dyspnea, and hypoxemia?

Dr. Smith's ECG Blog

AUGUST 14, 2023

Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chest pain, hypotension, dyspnea, and hypoxemia. The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) An 80-something woman who presented with chest pain and dyspnea.

Chest Pain

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

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.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

Dr. Smith's ECG Blog

DECEMBER 20, 2013

He said that his pain does not feel like his previous episode of pericarditis, and is not related to meals. He denied chest pain, shortness of breath, nausea, fever, chills, rashes, cough, and leg pain. Does subsegmental pulmonary embolism matter? The ST/T ratio in V6, however, is slightly greater.

Pericarditis

Pericarditis Chest Pain Pulmonary STEMI

Are these Wellens' waves?

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

No definite evidence of RV hypertrophy (normal axis, no large R-wave in V1) Late transition typical of COPD (R/S = 1 in V5) No evidence of old MI (no QS-waves in V1-V3, as seen in the presenting ECG) Other similar cases of acute right heart strain See this case of asthma whose ECG mimics acute PE: Is it pulmonary embolism? Kosuge et al.

Chest Pain

Chest Pain Pulmonary Tachycardia Embolism

Quiz post: do either or both of these patients have high lateral OMI / South African flag sign?

Dr. Smith's ECG Blog

JANUARY 12, 2023

Written by Pendell Meyers, edits by Smith Two patients presented with acute chest pain/pressure. Chest x-ray was read as normal. CT pulmonary angiogram was negative for pulmonary embolism. Two patients with chest pain. In a patient with chest pain — this is simply not a "normal" ST-T wave in lead V2.

Chest Pain

Chest Pain STEMI Blog Stenosis

Concerning EKG with a Non-obstructive angiogram. What happened?

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

Plaque Angina Blog Stents

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

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

Pay now (in the evening) or pay later with interest (in the middle of the night).

Dr. Smith's ECG Blog

MARCH 1, 2025

A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. The chest pain continued for hours. hours, another ECG was recorded.

Chest Pain

Chest Pain STEMI Stent Stents

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

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. Even if it is not atherosclerotic, young people can have embolic OMIs. But you are never too young to have an OMI.

STEMI

STEMI Pericarditis Chest Pain Echocardiogram

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

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

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

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Noisy, low amplitude ECG in a patient with chest pain

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

What does the ECG show in this patient with chest pain, hypotension, dyspnea, and hypoxemia?

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

Are these Wellens' waves?

Quiz post: do either or both of these patients have high lateral OMI / South African flag sign?

Concerning EKG with a Non-obstructive angiogram. What happened?

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

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

Pay now (in the evening) or pay later with interest (in the middle of the night).

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

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