Remove 2022 Remove Chest Pain Remove Exercise
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Chest pain, shortness of breath, T wave inversion, and rising troponin in a young healthy runner.

Dr. Smith's ECG Blog

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. Exercise test would also have been reasonable. Read about "exercise induced cardiac troponin elevations" here.

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Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

Dr. Smith's ECG Blog

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. American Journal of Emergency Medicine 2022 4.

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Syncope while on a treadmill

Dr. Smith's ECG Blog

Because the patient was exercising, which increases sympathetic tone, facilitating AV conduction. Why did today's patient develop AFlutter while exercising on a treadmill? Does Exercise Induce Non-Sinus Tachyarrhythmias? But how can the AV node conduct at a rate of 280? Why such rapid AV conduction?

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Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

The history is concerning ( This patient was awakened from sleep by chest pain that persisted for several hours — on a background of intermittent CP in recent weeks ). The ECG changes seen between the initial ECG and the repeat ECG after NTG — are undeniable! Nor was there a challenge to look for coronary spasm.

Ischemia 121
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Anterior OMI. What does the angiogram show?

Dr. Smith's ECG Blog

Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain. His ECG is shown below. Pretty obvious anterior current of injury. This was a machine read STEMI positive OMI. Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4.

STEMI 119
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American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

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.

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What is the infarct artery? What does the post PCI ECG show? What does the convalescent ECG show?

Dr. Smith's ECG Blog

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. He called 911. Here is the prehospital ECG.