Dr. Smith's ECG Blog

MARCH 27, 2025

"Hi Steve wonder what you think of this ecg in a 60 yo woman w cp, known CAD" Presentation ECG (ECG 1): Here is her previous from one week prior when she presented with heart failure and trops were "negative" (ECG 2): My response: "They both look like active ischemia. The previous ECG also shows active ischemia." Just awful all around.

Ischemia 105

Ischemia Chest Pain Cardiogenic Shock Heart Failure 105

Dr. Smith's ECG Blog

APRIL 6, 2025

There is Transmural ischemia of Occlusion MI. Spectral CT This spectral CT image really highlights the dense transmural ischemia of the posterior wall. Here you can also see that there is dense ischemia of the RV. Assessment : Cardiology thought this was cardiogenic shock from RV dysfunction.

Blood Pressure 110

Blood Pressure Cardiogenic Shock Ischemia Cardiac Arrest 110

Dr. Smith's ECG Blog

MARCH 25, 2025

There is low voltage in the precordium which always makes reading ischemia harder. In ACS, chest pain is the warning sign of ongoing ischemia. Smith : As Willy says, and as we've said many times before, morphine will resolve pain without resolving ischemia. ECG 1 What do you think? To me, this ECG is not diagnostic.

Chest Pain 62

Chest Pain Ischemia Plaque Stents 62

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. The patient was started on heparin for possible NSTEMI vs demand ischemia. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.)

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

JANUARY 11, 2025

The ECG shows sinus tachycardia, RBBB+LAFB, and signs of anterolateral acute transmural ischemia (most likely due to acute coronary occlusion), with concordant STE in I and aVL, inappropriate STE in V4-6 (though limited a bit by motion, still definite). Near 100% mortality without rapid reperfusion." The ST Elevation is NOT typical.

Cardiogenic Shock 136

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 136

Dr. Smith's ECG Blog

APRIL 16, 2025

Anyone who has seen and studied OMI patients knows that this patient with proximal LAD pattern, with super high risk ischemic RBBB, and tachycardia, is in cardiogenic shock until proven otherwise. This pattern has very high mortality. The Emergency Physician contacted the Cardiologist immediately asking for cath lab activation.

Chest Pain 100

Chest Pain STEMI Tachycardia Cardiac Arrest 100