Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Here’s the EMS ECG, digitized with PM cardio. What do you think? There’s sinus arrhythmia with normal conduction, normal axis and normal voltages. There’s loss of R waves in V2-3 with hyperacute waves V1-5.

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Chest Pain STEMI Blog Arrhythmia 66

DAIC

DECEMBER 19, 2023

This interest may be attributed in part to a 2021 decision by the American College of Cardiology (ACC) and the American Heart Association (AHA) to give cardiac CT angiography (CCTA) its highest recommendation as a frontline test to evaluate patients with stable and acute chest pain who have no history of coronary artery disease.¹

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Dr. Smith's ECG Blog

APRIL 25, 2023

Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. PEARL: Most patients who present with new chest pain + ECG changes + positive troponin — will not need Cardiac MRI. This was sent to me by a partner: "Curious what you think of this one we had overnight.

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Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. 2021 Dec 7;10(23):e022866. Epub 2021 Nov 15. Triage EKG: What do you think? J Am Heart Assoc. 121.022866.

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Chest Pain Blog Stenosis Myocardial Infarction 52

DAIC

MAY 8, 2024

5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. 5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. 2021, [link]. JAMA Internal Medicine, vol. 1071, [link]. 22, 30 Nov.

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Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

Dr. Smith's ECG Blog

APRIL 22, 2022

Written by Jesse McLaren, with comments from Smith and Grauer A 60 year old presented with three weeks of intermittent non-exertional chest pain without associated symptoms. A prospective validation of the HEART score for chest pain patients at the emergency department. Am J Med 2021 5. Int J Cardiol 2013 2.

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Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. Int J Cardiol Heart Vasc 2021 2. Today's patient is a 70-year old adult who called EMS because of new-onset chest pain , associated with nausea and shortness of breath. Who needs the cath lab?

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

HCPLive

MAY 20, 2024

An AAPA 2024 session reflected on the joint AHA/ACC chest pain guidelines, particularly the adoption of high-density troponin level testing since 2021.

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Chest Pain 59

Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 3, 2025

BACKGROUND:The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) demonstrated that a precision diagnostic strategy reduced the primary composite of death, nonfatal myocardial infarction, or catheterization without obstructive coronary artery disease by 65% in patients with nonacute chest pain (..)

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Chest Pain Outcomes Coronary Artery Disease Myocardial Infarction 40

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Annals of Emergency Medicine 2021. Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion.

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Chest Pain Myocardial Infarction STEMI Pacemaker 52

DAIC

MARCH 28, 2024

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. 2021 Nov 30;144(22):e368-e454. Epub ahead of print. PMID: 38483420. Circulation.

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Ischemia Chest Pain Atherosclerosis Coronary Artery Disease 110

Open Heart

AUGUST 25, 2024

Methods We prospectively included 1384 patients with LRHSs between March 2019 and March 2021. Therefore, this study aims to investigate the value of NISI in risk stratification and predicting cardiac events in patients with low-risk HEART scores (LRHSs).

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Chest Pain Coronary Artery Disease Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. He later developed mild continuous chest pain, that he describes as the sensation of someone standing on his chest. He was treated for infection and DKA and admission to hospital was planned.

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 118

Circulation

DECEMBER 10, 2023

Circulation, Volume 148, Issue 24 , Page e281-e281, December 12, 2023.

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Chest Pain Circulation 49

DAIC

MARCH 28, 2025

TheNational Institute for Health and Care Excellence(NICE) recommends CCTA as the first-line investigation for patients with chest pain due to suspected CAD, highlighting its importance in improving diagnostic certainty. June 11, 2021. link] iv IMV.2023 2023 CTMarket Outlook Report (p. v Walter, M. 2024,November 8).

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Technology Coronary Artery Disease Atrial Fibrillation Medicare 59

Ken Grauer, MD

FEBRUARY 3, 2024

As discussed in detail in ECG Blog #228 — this seemingly qualifies as a “ Silent ” MI ( Approximately half of those MIs not accompanied by CP — have some other associated symptom such as syncope, which substitutes as a “chest pain equivalent” ).

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Dr. Smith's ECG Blog

JULY 14, 2023

For example — Baldi et al note a more than doubling in the number of false-positive ECGs for STEMI i f judgments were based on post-resuscitation 12-lead tracings obtained less than 7 minutes after ROSC ( Resuscitation 162:445-446, 2021 ).

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Ken Grauer, MD

JUNE 14, 2024

Today's case is also noteworthy in that T-QRS-D is seen in association with RBBB — which has only been described on rare occasions ( See the March 28, 2021 post i n Dr. Smith's ECG Blog ). Prompt cath is therefore advised if the post-ROSC shows an acute STEMI. He became unconscious on arrival.

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Blog STEMI Cardiac Arrest Tachycardia 161

Ken Grauer, MD

OCTOBER 21, 2023

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. That said, when you do see inverted U waves ( as we do in ECG #1 ) — this is a significant marker of severe ischemia ( Duque-Gonzálex et al — Cardiovascular Metal Sci 32(4), 2021 ).

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Blog Chest Pain Ischemia STEMI 98

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 November 27, 2021 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ).

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Dr. Smith's ECG Blog

OCTOBER 1, 2023

This is a re-post of an excellent case from 2021. A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think?

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Stents Stent STEMI Physiology 127

Heart 2023 Conference

MARCH 5, 2023

Ella Dunmore, who is a mother and former soldier, made the decision to seek medical attention, she had been experiencing headaches, chest pain, and shortness of breath for several weeks. Dr. Kaki implanted Impella CP® on March 18, 2021, while he cleared blockages and inserted stents. Thought to share about it.

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Open Heart

JUNE 22, 2023

Methods RLCCTS started October 2021 using a wide detector array CT system, with 20 min slots. Six months of data were collected; stable chest pain (SCP) patients, who have national CTCA QC comparators, were analysed using descriptive statistics. Uncertain CAD-RADS meant a non-diagnostic scan (NDS).

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Chest Pain Coronary Artery Disease Technology Hospital 52

Journal of the American Heart Association

MARCH 27, 2025

years]) admitted to the China Chest Pain Center Database between 2016 and 2021. Hierarchical clustering of 15 medical conditions was performed to derive multimorbidity patterns. The primary outcome was a composite of inhospital adverse events.

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Myocardial Infarction Peripheral Arterial Disease Outcomes Chest Pain 40

DAIC

MARCH 11, 2024

a med tech company dedicated to helping patients with persistent ischemic heart disease, has announced the treatment of the first patient with the A-FLUX Reducer System, a treatment for patients with angina or chest pain. 27 May 2021. VahatiCor, Inc., Angina is often caused by reduced blood flow to the heart. Circulation.

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Angina Innovation Heart Disease Chest Pain 59

Dr. Smith's ECG Blog

MARCH 6, 2023

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation? However, in the context of the first ECG and the waning chest pain, this is diagnostic of reperfusion. Due to the severity of the pain and the high BP, they obtained an aortic dissection CT.

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Chest Pain STEMI Stenosis Blog 52

DAIC

JANUARY 3, 2024

With more than 500 peer-reviewed publications, the HeartFlow FFR CT Analysis remains unparalleled in precision coronary care, as supported by the ACC/AHA Chest Pain Guidelines, to improve treatment plans and outcomes. 2021 ACC/AHA Chest Pain Guidelines. For more information: www.heartflow.com References 1.

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All About Cardiovascular System and Disorders

FEBRUARY 24, 2024

Sometimes arrhythmogenic cardiomyopathy patients can present with acute chest pain and elevation of myocardial enzymes and has been called as ‘hot phase’ These require differentiation from acute myocardial infarction and have normal coronary arteries [3]. 2021 Jun 7;23(6):907-917. doi: 10.1093/europace/euaa343.

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Dr. Anish Koka

FEBRUARY 6, 2023

Cardiac Cath labs waiting for some major influx of COVID heart damage not only didn’t see patients presenting with COVID heart attacks, but they idled as patients terrified of coming to the hospital stayed home rather than come to the hospital with chest pain. But the politics was all pervasive. Anish Koka is a Cardiologist.

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Stroke Journal

JANUARY 30, 2025

we analyzed patients presenting from 2016 to 2021 with an initial diagnosis of stroke, defined by ICD-10 codes in any diagnostic position as abstracted from free text responses by ED staff. We therefore used population-level data to report the frequency of cardiac troponin assessments among U.S. 32.2%) had troponin tested in the ED.

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Stroke Strokes Chest Pain Myocardial Infarction 40

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.

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DAIC

MARCH 7, 2024

A 2021 study published in Radiology: Cardiothoracic Imaging focused on cardiac imaging trends over a decade. Standardized terminology allows for consistency in communication across all members of the imaging community and will assist with clinical care and multicenter trials.”

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Technology Document Cardiovascular Imaging Cancer 111

Dr. Anish Koka

FEBRUARY 13, 2023

We can argue endlessly about what exactly the risk of COVID19 was in the Spring of 2020, or 2021, but there should be little argument in 2023 that the risks of COVID pneumonia striking down a young healthy individual is now extremely low. Notice that there is no spike in myocarditis diagnoses until the second half of 2021.

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Dr. Smith's ECG Blog

JANUARY 3, 2022

This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chest pain. It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain.

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STEMI Myocardial Infarction Chest Pain Ischemia 52

Ken Grauer, MD

OCTOBER 13, 2023

She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. The October 25, 2021 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) reviews my approach to another case of a Dual-Level Wenckebach block. QUESTIONS: HOW would you interpret the rhythm in Figure-1 ?

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Blog Arrhythmia Bradycardia Download 159

Dr. Paddy Barrett

JANUARY 30, 2024

2021 Sep 15;339:219-224. “ If there ain’t no plaque, there ain’t no heart attack ” When used to assess those presenting with chest pain, the use of CTCA led to a 41% reduction in the risk of future major heart events, including heart attacks and death from coronary artery disease 2. Int J Cardiol.

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Dr. Smith's ECG Blog

NOVEMBER 13, 2022

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. 2021 Sep;49(6):488-500. STE in lead I and II are more subtle. A second ECG was taken at 15:16. Wait for the angiogram.

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