2025, Chest Pain and Stents - Cardiovascular Update

Will this case be flagged for Quality Improvement in the STEMI/NSTEMI Paradigm?

Dr. Smith's ECG Blog

MARCH 27, 2025

After only 90 minutes of chest pain, the first troponin was unsurprisingly in the normal range at 11ng/L (normal <26 in males and <16 in females), so the emergency physician waited for repeat troponin. Chest pain still persists. Paged cardiology 0800: patient complains of chest pain. Cardiology aware.

STEMI

STEMI Chest Pain Pericarditis Ischemia

Intravascular Imaging Can Improve Outcomes for Complex Stenting Procedures

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

Stents Stent Outcomes Coronary Angiogram

Revolution Vibe CT System Now Available from GE Healthcare

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.

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Is it possible that this patient with acute chest pain and this ECG does not need emergent intervention?

Dr. Smith's ECG Blog

MARCH 19, 2025

Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. The patient has acute persistent refrectory chest pain and elevated troponin.

Chest Pain

Chest Pain STEMI Stent Stents

A 34 yo Man with chest pain and Zero ST Elevation

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

Chest Pain STEMI Hospital Blood Pressure

What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?

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. The below ECG was recorded. What do you think?

Chest Pain

Chest Pain STEMI Myocardial Infarction Ischemia

Pay now (in the evening) or pay later with interest (in the middle of the night).

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. He reports this was similar to how he felt when he had his heart attack 4 years prior, now s/p 4 stents. The chest pain continued for hours. The patient was still having chest pain.

Chest Pain

Chest Pain STEMI Stent Stents

Look what happens when you advocate for your patient with a skeptical cardiologist.

Dr. Smith's ECG Blog

APRIL 11, 2025

He then provided some history: " Classic story for angina, few hours of crushing chest pain." Here is the cath report (TIMI-2 flow in the circumflex -- stented): Learning Point: Just because the cardiologist says it is "not a STEMI" and "wants to teach you about the ECG", it does not mean you should back down.

STEMI

STEMI Angina Chest Pain Bradycardia

‘NSTEMI’ or reperfused OMI? And which lesion is the culprit?

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. So which was the culprit?

Chest Pain

Chest Pain Stents Stent STEMI

Another MUST know ECG, and why its notoriety annoys Dr. Smith

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. At cath there was a 100% proximal LAD occlusion, which was opened and stented. The above ECG is from man in his 80s with crushing chest pain. Troponin T peaked at 9378 ng/L.

STEMI

STEMI Chest Pain Myocardial Infarction Ischemia

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

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

Chest Pain Ischemia Plaque Stent

"Anterior" ST Depression: Which Lesion is the Culprit?

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. The proximal and mid LAD stenoses were stented and the OM 2 was left alone. 5 years later ( now in 2025 ) the problem remains. Based on the EKGs, which lesion is most likely the culprit?

Ischemia

Ischemia Blog STEMI Coronary Angiogram

Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Total proximal LAD occlusion was found and stented at angiography soon after the ECG above. 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.

Cardiac Arrest

Cardiac Arrest STEMI Blog Ischemia

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

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 true AV groove LCx was "jailed" by the stent and appears occluded in the post PCI image. Here is an AP caudal view before and after PCI.

STEMI

STEMI Pericarditis Chest Pain Echocardiogram

Acute chest pain with LBBB and obvious OMI, worsening on serial ECGs, but repeatedly missed by physicians and Marquette 12SL

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 was treated with a drug eluting stent. It is awaiting FDA approval (but approved for 1.5 There is ST elevation in the inferior leads.

Chest Pain

Chest Pain Ischemia STEMI Blog

What is Wellens' syndrome? And what conditions mimic it?

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

Chest Pain STEMI Myocardial Infarction Stent

One of those ECGs you need to instantly recognize, which learners may struggle with at first

Dr. Smith's ECG Blog

JANUARY 11, 2025

Written by Pendell Meyers An adult man presented with acute chest pain. He had undergone stenting of the LAD several weeks ago (unclear whether elective for stable symptoms, or in response to acute coronary syndrome). Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA. 2:04 PM, post stent deployment You can see that even after complete restoration of flow, the ECG still looks terrible, V most of all. & Dawson, D.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Will this case be flagged for Quality Improvement in the STEMI/NSTEMI Paradigm?

Intravascular Imaging Can Improve Outcomes for Complex Stenting Procedures

Revolution Vibe CT System Now Available from GE Healthcare

Webinars

Is it possible that this patient with acute chest pain and this ECG does not need emergent intervention?

A 34 yo Man with chest pain and Zero ST Elevation

What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?

Pay now (in the evening) or pay later with interest (in the middle of the night).

Look what happens when you advocate for your patient with a skeptical cardiologist.

‘NSTEMI’ or reperfused OMI? And which lesion is the culprit?

Another MUST know ECG, and why its notoriety annoys Dr. Smith

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

"Anterior" ST Depression: Which Lesion is the Culprit?

Sometimes a patient is fortunate to have a cardiac arrest

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

Acute chest pain with LBBB and obvious OMI, worsening on serial ECGs, but repeatedly missed by physicians and Marquette 12SL

What is Wellens' syndrome? And what conditions mimic it?

One of those ECGs you need to instantly recognize, which learners may struggle with at first

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

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