2020 Chest Pain Physiology 
Dr. Smith's ECG Blog
JANUARY 17, 2023
A 60 year old with chest pain presented to the ED. In this case, lead I does not look bizarre, but all other leads do. == N OTE : The reasons I especially liked today's case are: i ) The patient presented with chest pain — so the importance of distinguishing artifact from reality can not be overstated! —
Ken Grauer, MD
SEPTEMBER 22, 2023
Impression: In this middle-aged man with palpitations and dyspnea, but no chest pain — I suspect that the T wave peaking and slight, upward-sloping chest lead ST elevation represent a repolarization variant. The February 11, 2020 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ).
Ken Grauer, MD
APRIL 18, 2023
Figure-1: The initial ECG in today's case — obtained from a 50-year old man with new chest pain. ( In contrast — it is EASY to overlook L A- L L reversal — because the ECG picture seen with this type of lead reversal does not immediately stand out as physiologically “off”. The February 11, 2020 post ( LA-RA reversal ).
Dr. Smith's ECG Blog
JANUARY 23, 2024
There was no chest pain. The physiologic reason for this — is thought to be the result of momentarily increased circulation from mechanical contraction arising from the "sandwiched in" QRS complex. This was written by Magnus Nossen The patient is a female in her 50s. She presented with a one week hx of «dizziness» and weakness.
Dr. Smith's ECG Blog
JANUARY 9, 2024
AV synchrony and physiologic ventricular depolarization the hemodynamics improved. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.
Dr. Smith's ECG Blog
NOVEMBER 8, 2022
The patient had come to the ED for SOB, but without any chest pain. Global hypokinesis with possible regional wall motion abnormality-inferior & inferolateral Compared to the Echo from 10/2020, there has been a significant interval change: 1. Therefore, as many as 11 of the 12 leads can look bizarre.
Dr. Smith's ECG Blog
FEBRUARY 28, 2020
And some similar ECGs from Pulmonary Embolism: A young woman with altered mental status and hypotension An elderly woman transferred to you for chest pain, shortness of breath, and positive troponin - does she need the cath lab now? It just doesn’t make physiologic sense to have deep T wave inversion in V1 and V3, but not in V2.
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