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."

Ischemia 106

Ischemia Chest Pain Cardiogenic Shock Heart Failure 106

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 125

Chest Pain STEMI Risk Factors Coronary Artery Disease 125

Dr. Smith's ECG Blog

JANUARY 11, 2025

Written by Pendell Meyers An adult man presented with acute chest pain. 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).

Cardiogenic Shock 137

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 137

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 74

Tachycardia Pulmonary Chest Pain Stenosis 74

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. It is not clear by her note what she meant by this (whether or not she recognized this EKG as diagnostic of transmural ischemia, and if so, of what territory) but emergent reperfusion therapy was not pursued.

Ischemia 88

Ischemia Blog STEMI Coronary Angiogram 88

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. Transient ischemia may lead to "stunning". The ECG below ECG was recorded on the scene. References: Kloner, R.

STEMI 114

STEMI Chest Pain Myocardial Infarction Ischemia 114

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 Stents 63

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 106

Blog STEMI Download Chest Pain 106

Dr. Smith's ECG Blog

JANUARY 21, 2025

He denied chest pain. Time 7 hours lead reversal There is limb lead reversal (QRS in I and aVL are now inverted), but nevertheless one can see that the ischemia appears to have resolved. Negative trops and negative angiogram does not rule out coronary ischemia or ACS. Next day, with K = 4.6 The evidence of OMI is gone.

Chest Pain 62

Chest Pain STEMI Tachycardia Myocardial Infarction 62

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. This distinction is further complicated because marked LVH may at times mask the ST-T wave changes of acute ischemia.

Cardiac Arrest 86

Cardiac Arrest STEMI Blog Ischemia 86

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. & Dawson, D.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75