Dr. Smith's ECG Blog

MARCH 31, 2023

It is from a 50-something with chest pain: What do you think? I first became interested in computerized ECG interpretation in the beginning of my academic days in the early 1980s ( References to some of my work appear below — as I believe I may have been the first family physician to publish in this area ).

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Chest Pain STEMI Blog Academic 52

Dr. Smith's ECG Blog

MAY 31, 2023

A 67 yo f developed chest pain this morning." See this case: A man his 50s with chest pain. Academic Emergency Medicine 27(S1): S220; May 2020. The Need for Prompt Cath: — Way # 1 — In a 67-year old patient with several hours of new chest pain — ECG #1 clearly fits the description of deWinter T waves.

STEMI 96

STEMI Chest Pain Myocardial Infarction Ischemia 96

DAIC

APRIL 2, 2025

Dr. Stone is Director of Academic Affairs for the Mount Sinai Health System and Professor of Medicine (Cardiology) and Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and the study chair of the ECLIPSE trial. These results extend the strong recommendations from recent U.S.

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Stents Stent Outcomes Coronary Angiogram 40

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. Of academic interest — are the arrhythmias that developed.

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Tachycardia Chest Pain Academic Arrhythmia 133

Dr. Smith's ECG Blog

DECEMBER 11, 2023

See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. This is different from nitroglycerin which produces vasodilation and can improve by pain improving myocardial perfusion. You do not need to be better than the Queen of Hearts at EKG to understand that refractory chest pain NEEDS CATH NOW.

Myocardial Infarction 123

Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Dr. Anish Koka

MAY 16, 2023

This means that at every age, the probability a man complaining of chest pain has significant underlying coronary disease as a cause of this chest pain is much higher than a woman complaining of chest pain. Thanks for reading Dr. The data is overwhelming every way you can possibly look at it.

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

DECEMBER 19, 2018

A middle-aged woman had an acute onset of chest pain and dyspnea. The pain had almost resolved by the time an ECG was obtained in the ED: Here is the computer diagnosis What do you think? In the interest of academic discussion — I’ll add the following thoughts: The computer interpretation was obviously wrong.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Anish Koka

FEBRUARY 6, 2023

Cardiac Cath labs waiting for some major influx of COVID heart damage not only didn’t see patients presenting with COVID heart attacks, but they idled as patients terrified of coming to the hospital stayed home rather than come to the hospital with chest pain.

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COVID-19 Chest Pain Academic Hospital 52

DAIC

JANUARY 3, 2024

With more than 500 peer-reviewed publications, the HeartFlow FFR CT Analysis remains unparalleled in precision coronary care, as supported by the ACC/AHA Chest Pain Guidelines, to improve treatment plans and outcomes. Simon, MD , President, Academic & External Affairs and Chief Scientific Officer, University Hospitals Health System.

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Coronary Artery Disease Chest Pain Plaque Technology 59

Dr. Smith's ECG Blog

AUGUST 2, 2024

Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain. His ECG is shown below. Pretty obvious anterior current of injury. This was a machine read STEMI positive OMI. Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4.

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STEMI Ischemia Blog Chest Pain 119

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Definitive diagnosis that ECG #1 is in fact VT is more than academic.

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Tachycardia Cardiogenic Shock Angina Coronary Angiogram 139

Dr. Smith's ECG Blog

MAY 3, 2024

Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain? Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock.

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Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

Circulation

NOVEMBER 11, 2024

Data were derived from the American College of Cardiology Chest Pain – MI Registry data collected by trained abstractors at the facility and were verifed by the study team.

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Chest Pain Academic Circulation 40

Dr. Smith's ECG Blog

JUNE 12, 2017

This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chest pain. link] Here is the history: A 30 yo man presented complaining of severe chest pain.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. He called 911. Here is the prehospital ECG.

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Aneurysm Chest Pain Cardiogenic Shock Blog 66

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Other cases of LAD OMI with RBBB/LAFB: A man in his 40s who really needs you to understand his ECG Cardiac Arrest at the airport, with an easy but important ECG for everyone to recognize A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia Ventricular Fibrillation, ROSC after perfusion restored by ECMO, then ECG.

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Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

The chest pain quickly subsided. This distinction is more than academic — because both treatment and the response to therapy tend to be different with these 2 entities. The T-waves have more area under the curve than baseline, but don't appear like typical hyperacute T waves. Are you worried about OMI in this case?

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Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

Dr. Smith's ECG Blog

AUGUST 26, 2009

This is a 58 year old male with 40 minutes of chest pain of acute onset. He was given aspirin and sublingual nitroglycerine, which improved his pain. Published in Academic Emergency Medicine, vol. The cath lab was activated by the paramedics. On arrival, the following ECG was recorded. 18 (5 Suppl 1):Abstract 425, p.

STEMI 52

STEMI Catheterization Laboratory Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Distinction of PMVT vs VFib is an academic one in this case ).

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. Academic Emergency Medicine 27(S1): S220; May 2020. Setting – large, academic, suburban ED. Abstract 556.

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STEMI Myocardial Infarction Ischemia Academic 78

EMS 12-Lead

APRIL 14, 2022

Factors consistently manifesting as such, in addition to chest pain, include, diaphoresis, vomiting, radiation of pain (most alarming when inclusive of both arms), and pain aggravated by exertion. [1] It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS).

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ACE Inhibitor Physiology Chest Pain Academic 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. M Y A NSWER: In my opinion — it is both academic and clinically unimportant ( as well as often impossible ) to attempt to distinguish between sinus rhythm with multiple different-looking PACs vs MAT. Here is the ECG: What do you think?

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Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Anish Koka

FEBRUARY 13, 2023

More evidence this past week that vaccine myocarditis is very much a real entity while COVID19 myocarditis is mostly a fabrication of academic researchers comes from Scandinavian countries. Subscribe for free to receive new posts and support my work. Notice that there is no spike in myocarditis diagnoses until the second half of 2021.

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COVID-19 Public Health Pediatrics Chest Pain 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A recent similar case: A 40-something with chest pain. PEARL #2 — Distinction between PMVT vs Torsades is more than academic. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. Is this inferior MI?

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Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Anish Koka

DECEMBER 12, 2022

It is interesting particularly because the ensconced narrative in academic circles and the medically related twitterati that seem to have an outsized influence on COVID related policy has been that vaccine myocarditis is “mild” Leo Lam, Ph.D.💉⚕️🌎🇺🇸🇬🇧🏴󠁧󠁢󠁳󠁣󠁴󠁿🇭🇰

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Sudden Cardiac Death Chest Pain Hospital Heart Failure 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Academic Emergency Medicine., Academic Emergency Medicine, 2003 Volume 10, Number 5 539-540.

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Arrhythmia Outcomes Risk Factors Chest Pain 52

American College of Cardiology

FEBRUARY 1, 2025

That's the only way we can give women a definitive diagnosis for what's causing their chest pain." The paper specifically notes that it operates "differently than some traditional prevention centers because it assesses for obstructive as well as nonobstructive causes for IHD."14

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Cardiovascular Disease Education Coronary Artery Disease Risk Factors 42

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.

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Chest Pain STEMI Myocardial Infarction Ischemia 106

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. What do you think? I responded: "Definite inferior OMI. And Right Ventricular.

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Academic Stents Stent Thrombosis 126