Dr. Smith's ECG Blog

JANUARY 27, 2024

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. Old ‘NSTEMI’ A history of coronary artery disease and a stent to the same territory further increases pre-test likelihood of acute coronary occlusion, including in-stent thrombosis.

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Chest Pain STEMI Aneurysm Stents 117

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. 2024,November 8). 2012) 380:2095128. 10.1016/S0140-6736(12)61728-0. link] iv IMV.2023 v Walter, M.

Technology 59

Technology Coronary Artery Disease Atrial Fibrillation Medicare 59

DAIC

APRIL 8, 2024

The study focused on patients who underwent PCI for acute coronary syndromes (ACS)—life-threatening conditions which include heart attacks and chest pain caused by decreased blood flow to the heart—with stents containing drugs to prevent further plaque buildup. Stents were supplied by Medtronic Corp. Minnesota, U.S.)

Heart Attack 111

Heart Attack Heart attacks Stent Stents 111

DAIC

APRIL 11, 2024

At two years, people who underwent preventive PCI were 89% less likely to experience the composite primary endpoint of cardiac death, heart attack in the target vessel, revascularization due to ischemia in the target vessel or hospitalization for unstable or progressive chest pain compared with people who received medications alone.

Plaque 111

Plaque Heart Attack Heart attacks Coronary Artery Disease 111

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4137144-A4137144, November 12, 2024. Introduction:Subacute stent thrombosis (ST) is related to high rates of cardiac reinfarction. We present a case of reinfarction from ST.

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Chest Pain Coronary Artery Disease Angioplasty Thrombosis 40

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Int J Cardiol 2024 3. Eur Heart J Digital Health 2024 5. Amsterdam et al. Circulation 2014 2.

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

Ken Grauer, MD

OCTOBER 25, 2024

P.S.: Cardiac cath was performed — and showed a distal LA D "culprit" lesion that was successfully stented. The following are the KEY clinical and ECG features that establish the diagnosis of W ellens ' S yndrome : There should be a history of prior chest pain that has resolved at the time the defining ECG is obtained.

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Blog Chest Pain STEMI Cardiogenic Shock 95

Dr. Smith's ECG Blog

JUNE 11, 2024

Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Chest pain and a computer ‘normal’ ECG.

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Chest Pain STEMI Blog Exercise 113

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart Attack 120

DAIC

MAY 14, 2024

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death. Accessed May 2024. For more information: www.gehealthcare.com References: 1 World Health Federation.

Coronary Artery Disease 111

Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast. The patient was given opiates which improved his chest pain to 7/10. The consulting cardiologist wrote in their note: “Could be cardiac chest pain. She is usually incredibly good at recognizing them!

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Chest Pain Blog Hospital Tachycardia 120

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 arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. It was stented. This was a large OMI.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stents 116

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. At that visit the patient was found to have an in-stent RCA occlusion. The patient was referred emergently to the cath lab, and again there was an in-stent RCA occlusion. What do you think? Troponin I peaked at 18.323ng/L.

Chest Pain 111

Chest Pain Pacemaker Ischemia Stents 111

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.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

JULY 14, 2024

Sent by anonymous, written by Pendell Meyers Case 1: A man in his 50s presented with acute chest pain. The cath lab was activated, and then not cancelled, and the angiogram showed 99% TIMI 2 flow proximal LAD culprit lesion, stented in less than 90 minutes of arrival. Normal vital signs. Normal vitals. What do you think?

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AFIB Stents Stent Chest Pain 105

Dr. Smith's ECG Blog

OCTOBER 6, 2024

This patient had the onset of chest pain 24 hours before arrival to the ED. The door to balloon time was incredibly short and there was a 100% circumflex occlusion that was opened and stented. For more on ECG findings in pulmonary disease — Check out My Comment in the May 31, 2024 post in Dr. Smith's ECG Blog ).

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Hospital Chest Pain Blog Pulmonary 77

Dr. Smith's ECG Blog

OCTOBER 22, 2024

He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. Successful primary angioplasty of the mid-circumflex artery towards the main marginal branch with the implantation of a drug-eluting stent. You must record frequent serial ECGs for patients with chest pain.

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Chest Pain STEMI Myocardial Infarction Angioplasty 66

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4145631-A4145631, November 12, 2024. This was treated with a drug-eluting stent, but TIMI 3 flow was not achieved. Due to ongoing shock despite initial mechanical support, the patient was escalated to an Impella CP device after a transthoracic echo confirmed no left ventricle thrombus.

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Aortic valve TAVR Aortic Chest Pain 40

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4139995-A4139995, November 12, 2024. Patients without data on C-reactive protein and high-density lipoprotein cholesterol and those who had a history of coronary artery bypass grafting and stenting in the left anterior descending artery were excluded. Recently, Rinaldi et al.

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Coronary Artery Bypass Graft Chest Pain Angina Cholesterol 40

Dr. Smith's ECG Blog

JANUARY 5, 2024

The patient said his chest pain was 4/10, down from 8/10 on presentation. On the combined basis of angiography and IVUS, this patient received stents to his mid RCA, proximal PDA, and OM. RCA and PDA before and after, arrows indicating stented regions. OM before and after, arrow indicating stented region.

Angina 121

Angina Plaque Document Stents 121

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. The patient was sent home with a prescription for omeprazole to treat presumed peptic disease.

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Outcomes Stenosis Outpatient Echocardiogram 113

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. The operator documented thoughtful consideration of risks and benefits of stent placement. Technically, there was a very narrow landing zone for the stent, and missing this could result in "jailing" the LCx, which is ideally avoided.

Plaque 66

Plaque Stents Stent Chest Pain 66

DAIC

APRIL 8, 2024

At that time, the damage to the heart muscle was greater than we see today, and we didn’t have the possibility to revascularize patients with percutaneous coronary intervention and stents like we do today,” Yndigegn said. Over a median follow-up period of 3.5

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Heart attacks Heart Attack Heart Failure Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. She presented to the emergency department after a couple of days of chest discomfort. She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. The last echocardiography 12 months ago showed HFmrEF.

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

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 Stents Stent 110

Dr. Smith's ECG Blog

OCTOBER 30, 2024

All of the patients contacted EMS due to acute onset chest pain. The above ECG is from a 70 something male with chest pain. ECG #2 Case 2 : The above ECG was obtained from a diabetic 45 year old smoker with chest pain. Following the improvement in the ECG the patient's pain too improved drastically.

Chest Pain 111

Chest Pain Aortic Myocardial Infarction STEMI 111

Dr. Smith's ECG Blog

DECEMBER 10, 2024

Written by Pendell Meyers An elderly female called EMS with acute chest pain. Putting It All Together As per Dr. Meyers the case ended well with cardiac cath showing an RCA "culprit" which was successfully stented. Her vitals were within normal limits, and here is her EMS ECG: What do you think?

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Chest Pain Ischemia Echocardiogram Stents 108

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Written by Willy Frick A young woman with a history of paroxysmal nocturnal hemoglobinuria presented with acute substernal chest pain. The report describes heavy plaque in the proximal RCA by IVUS, but no lesions in the previously occluded RPL branch and no stent was deployed. Smith : The cath lab should be activated now!

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Chest Pain Hospital Anatomy Aneurysm 66

Dr. Smith's ECG Blog

DECEMBER 29, 2024

Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. So let's pretend this is acute chest pain. In the November 27, 2024 post Drs. If no, then she will tell you that the case is outside of the intended use group. What do you think?

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Stents Stent Chest Pain Angina 66

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. What do you think? I responded: "Definite inferior OMI. And Right Ventricular.

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Academic Stents Stent Thrombosis 126

Dr. Smith's ECG Blog

NOVEMBER 8, 2024

Written by Magnus Nossen The below ECG was obtained from a 65 year old man with ongoing chest pain. The below ECG was obtained 45 minutes after the first one with the patient being free of chest pain at the time of recording of ECG #2. He remained chest pain free and underwent coronary angiography the following day.

Chest Pain 101

Chest Pain Myocardial Infarction Hypertension Hospital 101

Dr. Smith's ECG Blog

JANUARY 31, 2025

The patient contacted the ambulance service after he experienced sudden onset chest pain and diaphoresis that had started 20 minutes prior. At cath there was a 100% proximal LAD occlusion, which was opened and stented. The above ECG is from man in his 80s with crushing chest pain. 2024, January 31).

STEMI 114

STEMI Chest Pain Myocardial Infarction Ischemia 114

Dr. Smith's ECG Blog

JANUARY 5, 2025

Written by Willy Frick A man in his 60s with hypertension and prior stroke presented with three days of crushing chest pain. He reported intermittent chest pain for the last few months, but never lasting this long. The cardiology consultant notes that pain is "almost resolved." There is active infarction.

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Chest Pain Ischemia Angina Echocardiogram 77

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. After stent placement: The vessel is now open with TIMI 3 flow, although it is diffusely diseased and the middle segment is ectatic.

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Chest Pain Stents Stent Risk Factors 68

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

Written by Pendell Meyers, few edits by Smith A woman in her 70s was woken from sleep by midsternal chest pain radiating to left arm with nausea. My Comment , by K EN G RAUER, MD ( 11/10 /2024 ): = Think of today's case as a check of your skill in recognizing when to activate the cath lab. Queen of hearts explainability image.

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STEMI Chest Pain Echocardiogram Stents 81

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

1) Very high initial troponin of 45,000 ng/L 2) A full day of chest pain 3) Q-waves on the ECG, with some T-wave inversion Here is one frame of the CT scan which includes the heart: Can you spot the infarct? It was opened and stented. The November 8, 2024 post — artifact complicating OMI assessment. How do I know?

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Blog Chest Pain Myocardial Infarction Critical Care 63

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. He presented to the ED for evaluation chest pain. Pain was improved but not gone upon arrival.

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STEMI Chest Pain Myocardial Infarction Aneurysm 121