Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Former resident: "Just saw cath report, LAD stent was 100% acutely occluded." They of course opened and stented it. They said it looked similar to his old one (in my opinion, similar, but not similar enough to be able to say no OMI)." Smith : "What was the outcome?" You taught us well!"

Chest Pain 114

Chest Pain Aneurysm Stent Stents 114

Dr. Smith's ECG Blog

MARCH 22, 2024

I will leave more detailed rhythm discussion to the illustrious Dr. Ken Grauer below, but this use of calipers shows that the rhythm interpretation is: Sinus bradycardia with a competing (most likely junctional) rhythm. That is, until the 7th R wave which comes a little bit sooner than expected. Given the R-R interval = 1160 msecs.

Chest Pain 114

Chest Pain STEMI Bradycardia Ischemia 114

Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. He had multiple episodes of bradycardia and nonsustained ventricular tachycardia. It was stented. He wrote most of it and I (Smith) edited.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stent 116

Dr. Smith's ECG Blog

MAY 30, 2023

Here is his ED ECG: There is bradycardia with a junctional escape. Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. The April 17, 2022 post ( Leads V1,V2 misplacement ). What is the atrial activity?

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

JULY 16, 2022

This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain. The computer called "Sinus Bradycardia" only (implying that everything else is normal. The overreading Cardiologist called it only "Sinus Bradycardia" with no other findings. The rhythm in Figure-1 is sinus bradycardia and arrhythmia.

Chest Pain 52

Chest Pain Bradycardia Blog Critical Care 52

Dr. Smith's ECG Blog

JANUARY 15, 2023

Stent placed. The rhythm in ECG #1 is sinus bradycardia and arrhythmia. Increased J-point ST depression, with downslope sagging ST segments and terminal T wave positivity ( ie, markedly positive "Mirror" Test — as per My Comment in the September 21, 2022 post of Dr. Smith's ECG Blog ) — confirms acute posterior OMI.

Chest Pain 52

Chest Pain Blog Bradycardia Stent 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. 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. What do you think? Circulation 2014 7. -- McLaren JTT, Meyers HP, Smith SW, Chartier LB.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52