DAIC

MARCH 28, 2025

tim.hodson Fri, 03/28/2025 - 15:23 Mar. 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.

Technology 59

Technology Coronary Artery Disease Atrial Fibrillation Medicare 59

DAIC

MARCH 4, 2025

tim.hodson Tue, 03/04/2025 - 14:11 Feb. each year, according to the American Heart Association 2025 Heart Disease and Stroke Statistical Update. 22, 2025More than 60,000 people die from heart valve disease (HVD) in the U.S. AS occurs when the aortic valve narrows, restricting blood flow from the heart to the body.

Heart Valves 52

Heart Valves Aortic valve Aortic Stenosis 52

DAIC

APRIL 2, 2025

Stone, MD Mount Sinai Health System tim.hodson Wed, 04/02/2025 - 15:26 March 31, 2025 Using intravascular imaging (IVI) to guide stent implantation during complex stenting procedures is safer and more effective for patients with severely calcified coronary artery disease than conventional angiography, the more commonly used technique.

Stents 40

Stents Stent Outcomes Coronary Angiogram 40

DAIC

APRIL 6, 2024

Noel Bairey Merz, MD , director of the Barbra Streisand Women's Heart Center , will participate in a cardiovascular health for women session, “Where Are We Now: From WISE to CHEST PAIN Guidelines,” Sunday, April 7, 12:45-12:52 p.m. 24 that will bring together participants in the 2025 Clinical Trials Research (CTR) program.

Research 105

Research Cardiac Arrest Electrophysiology Chest Pain 105

Dr. Smith's ECG Blog

MARCH 19, 2025

He was given two separate sprays of nitroglycerin sublingually, neither of which improved his pain but did cause him to become briefly hypotensive ( 600 ng/L. The patient has acute persistent refrectory chest pain and elevated troponin. There is no need for another ECG. Just go to the cath lab!

Chest Pain 116

Chest Pain STEMI Stent Stents 116

Dr. Smith's ECG Blog

JANUARY 28, 2025

Written by Hans Helseth A 34 year old man with no known medical history presented to the ED after an hour of chest pain. He described the pain as a mid sternal "burning sensation" and rated it 8.5 out of 10 at onset, but on presentation to the ED, reported that the pain had improved to 4.5. 10 chest pain.

Chest Pain 105

Chest Pain STEMI Hospital Blood Pressure 105

Dr. Smith's ECG Blog

MARCH 14, 2025

He contacted EMS due to acute onset chest pain and feeling unwell and fatigued. He subsequently developed worsening chest pain. This, in the context of worsening chest pain , is evidence of reocclusion of the infarct-related artery and active OMI in development. See this case: A man his 50s with chest pain.

Chest Pain 106

Chest Pain STEMI Myocardial Infarction Ischemia 106

Dr. Smith's ECG Blog

APRIL 13, 2025

A man in his early 30s was walking when he developed central chest pain which was non-radiating, then had a syncopal event with bowel incontinence, and when he woke up he had ongoing chest pain. Notes never having symptoms like this before, pain is so severe its causing SOB. He called 911. As I wrote in that Nov.

Chest Pain 60

Chest Pain Embolism STEMI Plaque 60

Dr. Smith's ECG Blog

FEBRUARY 12, 2025

She did not even need to ask in this case, because even if the patient presented with chest pain, she would call it NEGATIVE. Fortunately, the physicians seeing the patient were using the Queen of Hearts PM Cardio AI ECG OMI Model, and she had absolutely no concerns.

Chest Pain 82

Chest Pain STEMI Electrocardiogram Blog 82

Dr. Smith's ECG Blog

JANUARY 24, 2025

The patient received three nitroglycerin tablets with significant "improvement" in his chest pain. Improved chest pain is unresolved chest pain. I am commonly told, and I commonly read in the chart that chest pain is resolved. It is not enough for the chest pain to be "much better."

Chest Pain 124

Chest Pain STEMI Risk Factors Coronary Artery Disease 124

Dr. Smith's ECG Blog

MARCH 1, 2025

A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. The chest pain continued for hours. hours, another ECG was recorded.

Chest Pain 121

Chest Pain STEMI Stent Stents 121

Dr. Smith's ECG Blog

MARCH 27, 2025

He stated later that he gave her 1 sublingual NTG and her pain went down to 1/10. This 60-year old woman clearly presented to the ED as a higher -risk patient given her history of known coronary disease, now with new chest pain. He did not repeat an ECG. His response: "Yeah, thats what I was afraid of.

Ischemia 106

Ischemia Chest Pain Cardiogenic Shock Heart Failure 106

Dr. Smith's ECG Blog

APRIL 11, 2025

He then provided some history: " Classic story for angina, few hours of crushing chest pain." For an example of how it can happen that potential false negative cardiac caths occur Check out the March 17, 2025 post. Cardiologists are rarely impressed because they do not understand OMI ECG findings. Use the Queen of Hearts!!

STEMI 119

STEMI Angina Chest Pain Bradycardia 119

Dr. Smith's ECG Blog

JANUARY 18, 2025

No chest pain. Im changed. == MY Comment , by K EN G RAUER, MD ( 1/16 /2025 ): == It's not often that we see a clinical entity for which it seems that the patient "read the textbook" before the ECG was recorded. hs Trop I is 15,000. I think it is OMI. Taking her to the cath lab. He wrote: OMI it was. Large diagonal. Now opened.

Myocardial Infarction 116

Myocardial Infarction STEMI Chest Pain Download 116

Dr. Smith's ECG Blog

MARCH 23, 2025

Written by Pendell Meyers, sent by anonymous, with additions by Smith A man in his 40s had acute chest pain and called EMS. 3) [link] Artificial intellingence based detection of acute coronary occlusion compared to STEMI criteria - External validation study in a consecutive all-comer German chest pain unit cohort.

STEMI 82

STEMI Chest Pain Myocardial Infarction Article 82

Dr. Smith's ECG Blog

FEBRUARY 8, 2025

Written by Jesse McLaren An 80 year old with a history of CHF, ESRD on dialysis, and multiple prior cardiac stents presented to the emergency department with 3 days of intermittent chest pain and shortness of breath that resolved after nitro, which felt like prior episodes of angina. The patient had no further episodes of chest pain.

Chest Pain 64

Chest Pain Stent Stents STEMI 64

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. The above ECG is from man in his 80s with crushing chest pain. New England Journal of Medicine. == MY Comment, by K EN G RAUER, MD ( 1/26/2025 ): == "Some patients read the textbook.

STEMI 113

STEMI Chest Pain Myocardial Infarction Ischemia 113

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. She awoke in the morning with sharp chest pain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

MARCH 17, 2025

Written by Willy Frick A man in his 60s with a history of hypertension and 40 pack-year history presented to the ER with 1 day of intermittent, burning substernal chest pain radiating into both arms as well as his back and jaw. It has been stuttering, lasting 10 minutes at a time with associated diaphoresis.

STEMI 81

STEMI Chest Pain Myocardial Infarction Document 81

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

Chest Pain 63

Chest Pain Ischemia Plaque Stent 63

Dr. Smith's ECG Blog

JANUARY 21, 2025

He denied chest pain. It is correct that he did not have chest pain, but we must remember that fully 1/3 of full blown STEMI do not present with chest pain. I read them without clinical context and looked at the clinical context later. Bedside POCUS showed very poor LV function and a few pulmonary B lines.

Chest Pain 61

Chest Pain STEMI Tachycardia Myocardial Infarction 61

Ken Grauer, MD

JANUARY 2, 2025

PEARL # 2: Did you notice in the post-conversion tracing that there is ST segment coving with fairly deep T wave inversion in the chest leads? Clinical correlation, and possibly Troponin levels are needed to determine whether this deep T wave inversion needs additional evaluation ).

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Blog Chest Pain Bradycardia Tachycardia 168

Ken Grauer, MD

MARCH 8, 2025

The ECG in Figure-1 was obtained from a middle-aged man who presents to the ED ( E mergency D epartment ) with 6 hours of chest pain. Figure-1: The initial ECG in today's case obtained from a middle-aged man with 6 hours of chest pain. ( He is hemodynamically stable. They lead you to numerous posts with more on OMIs.

Blog 105

Blog STEMI Download Chest Pain 105

Dr. Smith's ECG Blog

MARCH 9, 2025

A 62 year old man with hyperlipidemia presented to a rural emergency department with 7 hours of 3/10 chest pain. 5 years later ( now in 2025 ) the problem remains. In fact, much of what passes for EKG education can actually harm one's interpretation skills.

Ischemia 88

Ischemia Blog STEMI Coronary Angiogram 88

Dr. Smith's ECG Blog

FEBRUARY 16, 2025

This is a very bold statement in a type 1 diabetic with very concerning sounding chest pain. The patient was treated with aspirin and a GI cocktail, which did not help the pain. The emergency medicine physician documented, "His initial EKG is riddled with artifact and difficult to interpret but does not look like a STEMI."

STEMI 72

STEMI Pericarditis Chest Pain Echocardiogram 72

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Long term outcome is not available. == MY Comment, by K EN G RAUER, MD ( 2/1/2025 ): == We need to learn from cases like today's. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH.

Cardiac Arrest 86

Cardiac Arrest STEMI Blog Ischemia 86

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. Ninety percent of patients with reperfusion attained a maximum T wave negativity of 3 mm or more within 48 hours after the onset of chest pain in the lead that initially displayed the greatest ST segment elevation. Below is his presentation ECG.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Dr. Smith's ECG Blog

APRIL 9, 2025

A middle-age woman with no previous cardiac history called 911 for chest pain. This was her prehospital ECG: What do you think? There is sinus rhythm with RBBB and obvious LAD OMI (proximal LAD occlusion): hyperacute T-waves in I, aVL and minimal STE in V1, V2. I focus my comment on expanding as to why this is so.

Defibrillator 63

Defibrillator Cardiac Arrest Myocardial Infarction STEMI 63

Dr. Smith's ECG Blog

JANUARY 23, 2025

Case A 76 year old man with chronic hypertension but no history of coronary disease or myocardial infarction presented to the ED with chest pain at 2343. It is awaiting FDA approval (but approved for 1.5 There is ST elevation in the inferior leads. The Queen of Hearts recognizes this as OMI ("STEMI/STEMI Equivalent").

Chest Pain 116

Chest Pain Ischemia STEMI Blog 116

Dr. Smith's ECG Blog

JANUARY 13, 2025

A 50-something male presented to triage with chest pain for one day. A Chest X-ray showed infiltrates. Thus, another etiology of chest pain is found, and the fever suggests "fever-induced Brugada." The presenting complaint noted at Triage was, "a 50yo man with chest pain!" The temperature was 39.5

Chest Pain 71

Chest Pain Cardiac Arrest Ischemia Sudden Cardiac Death 71

Dr. Smith's ECG Blog

APRIL 2, 2025

A 30 year old African American Male presented to the ED with chest pain that occurred the day before. There was no pain on the day of presentation. 2019.06.007) (Full text here: [link] ) The ECG above is diagnostic of Wellens' syndrome (full reference below): 1) Episode of anginal chest pain that is resolved (GONE!)

Chest Pain 75

Chest Pain STEMI Myocardial Infarction Stent 75

Dr. Smith's ECG Blog

JANUARY 11, 2025

Written by Pendell Meyers An adult man presented with acute chest pain. Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin. What is the Diagnosis in this 70-something with Chest Pain? 68 minutes with chest compressions, full recovery.

Cardiogenic Shock 137

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 137

Dr. Smith's ECG Blog

MARCH 6, 2025

With OMI, all you know is that your patient has some nonspecific chest pain, SOB, shoulder pain etc. First, When you have a rhythm problem, you know you have a problem because the rate is either fast, slow, or irregular. which is probably NOT due to acute MI.

Tachycardia 95

Tachycardia Dysrhythmia ICU Pulmonary 95

Dr. Smith's ECG Blog

MARCH 8, 2025

He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. The cardiologist thought she had stent thrombosis which is possible, but I do not necessarily think is sufficient to explain her complete hemodynamic collapse. & Dawson, D. Circulation , 145 (13), 10021019.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75