Dr. Smith's ECG Blog

JULY 7, 2023

An 80-something woman who presented with chest pain and dyspnea. That said — QOH is already highly sophisticated and accurate in her assessment of ECGs from acute chest pain patients, in which the ECG is not complicated by uncommon OMI mimics. After all, this patient did also present with chest pain. ) — See below.

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Chest Pain AFIB Blog Atrial Fibrillation 52

Dr. Smith's ECG Blog

JULY 14, 2024

Sent by anonymous, written by Pendell Meyers Case 1: A man in his 50s presented with acute chest pain. Click here to sign up for Queen of Hearts Access Case 2: A woman in her 60s presented with acute chest pain. Normal vital signs. Here is his ECG at triage: What do you think? Normal vitals. What do you think?

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AFIB Stents Stent Chest Pain 107

Dr. Smith's ECG Blog

JULY 5, 2023

The patient has acute chest pain. Tall R wave in lead V1 and/or early transition in the chest leads ( reflecting increased "septal" forces ). WPW Cardiac arrhythmias ( especially AFib ). This was texted to me in real time. What do you think? Here was my answer: "Not ischemia. Maybe HOCM or another form of LVH.

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Chest Pain STEMI Congenital Heart Disease Heart Disease 52

Dr. Smith's ECG Blog

SEPTEMBER 24, 2023

This is written by Magnus Nossen, with some edits by Smith This ECG diagnosis will be obvious to the majority of the readers of this blog. A 50 something male was seen in the emergency room due to typical chest pain. The pain had started the same day about two hours prior to medical contact. The first ECG is shown below.

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Chest Pain Atrial Fibrillation AFIB Myocardial Infarction 87

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Diagnosis : Atrial flutter with 1:1 conduction, with fast AV conduction made possible by sympathetic drive of exercise On arrival, we obtained another 12-lead: Unremarkable Further history: One month history of shortness of breath on exertion, denies palpitations, chest pain, orthopnea, leg swelling.

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Atrial Flutter Exercise AFIB Tachycardia 65

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. The April 6, 2023 post — excessive baseline artifact misdiagnosed as AFib ( instead of sinus rhythm with AV Wenckebach — as in Figure-4 in this post ). The January 15, 2024 post — for an OMI despite lots of artifact!

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Atrial Fibrillation Tachycardia Blog Chest Pain 82

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? Despite the irregularity of QRS complexes — this rhythm is not AFib — because at least some definite P waves are present ( RED arrows that I added at the bottom of ECG #1 ).

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Cardiogenic Shock Cardiac Arrest Hospital Ischemia 128

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. I focus my comment on a few additional aspects regarding new AFib. The Importance of History: We are told that today’s patient is an otherwise healthy woman — who presented to the ED for new AFib.

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? Now another, with ultrasound.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 116

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient also has a history of AFib and HFmrEF ( = H eart F ailure with M inimally- R educed E jection F raction ). This patient presented to the ED “after a couple of days of chest discomfort”. I have emphasized on many occasions in Dr. Smith's ECG Blog how AFlutter is by far (!)

Tachycardia 121

Tachycardia Electrophysiology Atrial Flutter Ischemia 121

Dr. Smith's ECG Blog

MAY 26, 2023

And she does not know that this is an overdose; she thinks it is a patient with chest pain!! This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated. 3 hours later, this was recorded at a K of 2.8

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Cardiogenic Shock Arrhythmia Blog Education 98

Dr. Smith's ECG Blog

AUGUST 13, 2020

9 Hours of Chest Pain and Deep Q-waves: Is it too late for Thrombolytics? As per Dr. Smith — this suggests that despite QRS widening, the rhythm in ECG #3 is AFib with a rapid ventricular response. FINAL PEARL #3: When AFib is fast — the rhythm may at first glance look like it is regular. LV Aneurysm?

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. See this case: what do you think the echocardiogram shows in this case?

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Ischemia STEMI Stenosis Chest Pain 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: The issue of whether C omputerized E CG I nterpretations are “at fault” for an inaccurate ECG diagnosis has been addressed numerous times on this blog. The patient in this case presented with dyspnea and chest pain.

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Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Smith's ECG Blog

OCTOBER 28, 2023

There was some dyspnea but no chest pain. Tall R wave in lead V1 and/or early transition in the chest leads ( reflecting increased "septal" forces ). WPW Cardiac arrhythmias ( especially AFib ). A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. Here is his ECG.

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Preserved Ejection Fraction Sudden Cardiac Death Heart Failure Chest Pain 58

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

JANUARY 26, 2023

and if not — Is the rhythm “irregularly irregular”, as in AFib — or is there a pattern of “regular" irregularity in the form of group beating ? ). This may lead to a series of symptoms similar to “pacemaker syndrome” ( ie, dizziness, fatigue, light-headedness, presyncope/syncope, dyspnea and/or chest pain ). What is the R ate?

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Pacemaker Chest Pain AFIB Blog 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2020

There was no chest pain — and all troponins were negative. Extending beyond the scope of this emergency medicine ECG Blog — is that clinical and ECG manifestations of the various subtypes of cardiac amyloidosis may vary depending on the specific type of this deposited protein. Atrial arrhythmias ( especially AFib or AFlutter ).

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Atrial Flutter Cardiomyopathy Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. Comment by K EN G RAUER, MD ( 2/11 /2023 ): = Today’s case is from a patient with “many complaints”, including chest pain — and, an ECG that raised concern about acute anterior OMI. Chest pain was just one of these complaints. The ioninzed calcium was 6.5

Chest Pain 52

Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. E CG # 2 in Figure-1 is from the October 16, 2019 post on Dr. Smith’s Blog. BP:143/99, Pulse 109, Temp 37.2 °C C (99 °F), Resp (!)

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

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Chest Pain Embolism Pulmonary Tachycardia 114

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

1) Very high initial troponin of 45,000 ng/L 2) A full day of chest pain 3) Q-waves on the ECG, with some T-wave inversion Here is one frame of the CT scan which includes the heart: Can you spot the infarct? SUBACUTE) OMI, that would result in an undesirable delay. But this is clearly a subacute MI, with most of the damage done.

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Blog Chest Pain Myocardial Infarction Critical Care 64