Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered.

Chest Pain 82

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

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

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 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

OCTOBER 23, 2022

She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. 2. . == == MY Comment by K EN G RAUER, MD ( 10/23/2020 ): == There are a number of important lessons worthy of repeating from today's repost of our case from March 28, 2017.

STEMI 40

STEMI Chest Pain Hospital Risk Factors 40

Dr. Smith's ECG Blog

APRIL 15, 2020

Angiogram: Severe coronary artery calcification Moderate to severe distal small vessel disease mainly seen in RPL1, 2 Otherwise, Mild plaque, no angiographically significant obstructive coronary artery disease. IF interested in more on the topic of fragmentation — See My Comment in the January 31, 2020 post.

Tachycardia 52

Tachycardia Nursing Heart Disease Dysrhythmia 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A recent similar case: A 40-something with chest pain. 3 of the 4 have similarly bizarre PVCs. == MY Comment by K EN G RAUER, MD ( 4/29/2020 ): == Cardiac Arrest with Bizarre PVCs/Torsades de Pointes: Intriguing case with many interesting features. Is this inferior MI? There is a bigeminy with very Bizarre looking PVCs.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

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 64

Chest Pain Blog Arrhythmia Critical Care 64

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. There are multiple possible clinical situations that could account for diffuse subendocardial ischemia that is not due to ACS and plaque rupture. The syncope lasted about 2-3 minutes according to his wife.

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

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 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Paddy Barrett

AUGUST 1, 2023

A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. 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.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Paddy Barrett

SEPTEMBER 5, 2023

Share Let’s first state our goal when we are in the business of ‘Heart Disease Prevention’: To delay the onset of coronary artery disease (atherosclerosis/plaque) that might rupture and cause a heart attack. And the less plaque you have, the lower the risk of a heart attack. And it’s also WAY more common.

Plaque 52

Plaque Exercise Heart attacks Heart Attack 52

Dr. Paddy Barrett

DECEMBER 5, 2023

Whether stenting a narrowed coronary artery improves symptoms such as chest pain (angina) or shortness of breath is a very different question. The cause of angina usually involves inadequate blood flow reaching the heart muscle because of significant narrowing of the artery due to plaque buildup. 2020 Apr 9;382(15):1395-1407.

Stents 59

Stents Stent Angina Heart attacks 59

Dr. Paddy Barrett

NOVEMBER 28, 2023

Arteries generally narrow and occlude for one of two reasons: The progressive accumulation of plaque. A plaque ruptures, and a clot forms in the artery, thereby occluding it. There are the ‘garden variety’ heart attacks whereby a plaque ruptures in the coronary artery, called a spontaneous heart attack. N Engl J Med.

Stents 53

Stents Stent Heart attacks Heart Attack 53

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] 2] Although the clinical context in today’s case does not fit these descriptors for Type I OMI (e.g. 5] Isnard, R.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Dr. Smith's ECG Blog

MARCH 19, 2025

Influenza-like illness can also trigger plaque rupture. He was given two separate sprays of nitroglycerin sublingually, neither of which improved his pain but did cause him to become briefly hypotensive ( 600 ng/L. The patient has acute persistent refrectory chest pain and elevated troponin. Just go to the cath lab!

Chest Pain 116

Chest Pain STEMI Stents Stent 116

Dr. Smith's ECG Blog

APRIL 13, 2025

A man in his early 30s was walking when he developed central chest pain which was non-radiating, then had a syncopal event with bowel incontinence, and when he woke up he had ongoing chest pain. Notes never having symptoms like this before, pain is so severe its causing SOB. He called 911. Embolism with lysis.

Chest Pain 84

Chest Pain Embolism STEMI Plaque 84

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 121

Chest Pain STEMI Stents Stent 121