2025 Chest Pain STEMI 
Dr. Smith's ECG Blog
MARCH 10, 2025
Written by Jesse McLaren A 50 year old presented to triage with one hour of chest pain, and the following ECG labeled normal by the computer (GE Marquette SL) algorithm. Smith comment: we showed that the first troponin, even in full-blown STEMI, is negative 25% of the time. What do you think?
Dr. Smith's ECG Blog
MARCH 27, 2025
Theres ST elevation in V3-4 which meets STEMI criteria, which could be present in either early repolarization, pericarditis or injury. Lets see what happens in the current STEMI paradigm. Emergency physician: STEMI neg but with elevated troponin = Non-STEMI The first ECG was signed off. Chest pain still persists.
Dr. Smith's ECG Blog
MARCH 19, 2025
STEMI criteria are only 43% sensitive for OMI. 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.
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.
Dr. Smith's ECG Blog
MARCH 14, 2025
He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. He contacted EMS due to acute onset chest pain and feeling unwell and fatigued. He subsequently developed worsening chest pain. Pain is improving and ischemic T-wave inversions are no longer present".
Dr. Smith's ECG Blog
FEBRUARY 12, 2025
Even before we have clinical context, this ECG simply does not appear concerning for OMI, notwithstanding the machine's interpretation ** ** ACUTE MI / STEMI ** **. But in the world of STEMI, this is a challenging ECG to most. There were 80 positives by STEMI criteria, 88 by device algorithm, and 77 by AI software.
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.
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