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 123

Chest Pain STEMI Risk Factors Coronary Artery Disease 123

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 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 87

Ischemia Blog STEMI Coronary Angiogram 87

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 112

STEMI Chest Pain Myocardial Infarction Ischemia 112

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 62

Chest Pain Ischemia Plaque Stent 62

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 61

Chest Pain STEMI Tachycardia Myocardial Infarction 61

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 85

Cardiac Arrest STEMI Blog Ischemia 85

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 103

Blog STEMI Download Chest Pain 103

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. Denying patients the potential benefit of revascularization just because their symptoms have lasted a certain amount of time shows poor understanding of the pathophysiology of myocardial ischemia. He presented to the emergency department for evaluation.

Chest Pain 88

Chest Pain Pericarditis Myocardial Infarction Dementia 88

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. His triage EKG is shown below: There is left bundle branch block, so the EKG must be evaluated for ischemia by Smith-modified Sgarbossa criteria.

Chest Pain 115

Chest Pain Ischemia STEMI Blog 115

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!" Ischemia or infarction.

Chest Pain 70

Chest Pain Cardiac Arrest Ischemia Sudden Cardiac Death 70

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 136

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 136

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 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74