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. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin. J Am Heart Assoc.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?

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Chest Pain Ischemia Aortic Aortic valve 40

DAIC

APRIL 1, 2024

Most cases go undiagnosed until the condition advances enough to create symptoms such as shortness of breath, chest pain or fatigue. AI algorithms could further improve care by using data from ultrasounds and other imaging devices to develop a digital twin of each patient. “The

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Technology Heart Disease Innovation Ultrasound 105

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

He was given aspirin and sublingual nitro and the pain resolved. Bedside cardiac ultrasound with no obvious wall motion abnormalities. Another ECG was recorded after the nitroglycerine and now without pain: All findings are resolved. He had a previous ECG on file: Proving the findings are new The cath lab was activated.

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Ischemia Plaque Stenosis Myocardial Infarction 116

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. But the History in today's case was acute shortness of breath with dizziness and lightheadedness — and, essentially without chest pain!

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Cardiogenic Shock Ultrasound Pulmonary Tachycardia 115

Dr. Smith's ECG Blog

JUNE 28, 2023

He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded. The bedside ultrasound (video not available) reportedly showed only a slightly reduced LV function. The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm. Here is the ECG: What do you think?

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Tachycardia Ultrasound Heart Disease Atrial Fibrillation 92

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.

Chest Pain 52

Chest Pain STEMI Stenosis Blog 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. Now another, with ultrasound. This is a quiz.

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Cardiac Arrest Chest Pain Embolism Pulmonary 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.

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Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Pads were placed with ultrasound guidance, so they were in the correct position. However, this is not SVT.

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Tachycardia Cardiogenic Shock Angina Coronary Angiogram 136

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. Fortunately, this operator used intravascular ultrasound (IVUS). Unfortunately, a few hours later the patient complained of recurrent chest pain. She took an oxycodone and called EMS. I sent this to Drs.

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Plaque Stent Stents Chest Pain 70

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. On medic arrival, she walked out of the house in no distress, but was diaphoretic.

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Plaque Chest Pain Thrombosis Stenosis 52

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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Coronary Angiogram Plaque Thrombosis STEMI 100

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 113

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. A emergent cardiology consult can be helpful for equivocal cases.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

There was no chest pain. So we did a bedside cardiac ultrasound. I’ve reviewed My Take on the ECG diagnosis of RVH on a number of occasions in Dr. Smith’s ECG Blog ( See My Comment at the bottom of the page in the March 6, 2022 and September 1, 2020 posts , to name just 2 ). But today's patient had no chest pain.

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Pulmonary Chest Pain Hypertension Tricuspid 40

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Dr. Nossen performed a bedside ultrasound which was interpreted as normal. See these similar cases: A man in his sixties with chest pain Why is there inferior ST elevation, and would you get posterior leads? Sudden CP and SOB with Inferior ST Elevation and in STE in V1. Is it inferior and RV OMI?

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Blog Bradycardia Ischemia Exercise 52

Dr. Anish Koka

SEPTEMBER 24, 2022

The current study should dispel the ludicrous notion that clinical myocarditis - a disease entity that comes to light when you have chest pain because cells in your heart are dying — is mild. The CDC study published in Lancet on previously healthy 12-29 years old’s is a survey-based study. That work is far from complete.

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COVID-19 Hospital Chest Pain Quality of Life 52

Dr. Smith's ECG Blog

JUNE 2, 2023

She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG?

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Tachycardia Cardiomyopathy Electrocardiogram Article 75

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. 25, 2022 ). Her Apple Watch suddenly told her that she is in atrial fibrillation.

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. She has already had syncope.

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Pericarditis Tachycardia Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. or 2) Inferior and lateral OMI that is beginning to reperfuse, even though the patient still has chest pain? ECG 1 What do you think?

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Chest Pain Ischemia Stent Stents 91