Ken Grauer, MD

FEBRUARY 18, 2023

The presenting complaint was chest pain — and the patient collapsed soon after arrival in the ED. Shark Fin" ST segment elevation is most often a sign of severe transmural ischemia that results from acute coronary occlusion. QUESTION: A cardiologist interpreted the rhythm in Figure-1 as VT ( V entricular T achycardia ).

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Blog AFIB Chest Pain STEMI 78

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

Written by Jesse McLaren, with edits from Smith A 30 year old with a history of diabetes presented with two days of intermittent chest pain and diaphoresis, which recurred two hours prior to presentation. The chest pain was refractory to nitro so the cath lab was activated: 100% proximal LAD and 99% mid circumflex occlusions.

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Chest Pain STEMI Ischemia Stenosis 52

BoardVitals - Cardiovascular

SEPTEMBER 29, 2017

Which of the vessels likely provides blood supply to the circled area in the below polar plot image in a patient with normal coronary anatomy? A 48 year-old female with hypertension, hyperlipidemia, chronic low back pain, and bilateral lower extremity neuropathy. Which of the vessels is likely the culprit vessel causing the ischemia?

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Chest Pain Certification Ischemia General Cardiology 52

Dr. Smith's ECG Blog

AUGUST 15, 2019

Written by Pendell Meyers A male in his early 50s presented with waxing and waning chest pain starting at rest. He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS. Here is his initial ECG: What do you think? mm), neither of it's neighbors have enough STE to meet criteria (V1 is close at 0.5

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STEMI Chest Pain Risk Factors Anatomy 52

Dr. Smith's ECG Blog

JUNE 28, 2019

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%.

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Dr. Smith's ECG Blog

AUGUST 28, 2020

This is ischemia until proven otherwise. A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock. I learned that the patient is on Sotalol for control of PVCs. This explains the long QT.

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Cardiogenic Shock Chest Pain Ischemia Stenosis 52

Dr. Smith's ECG Blog

AUGUST 9, 2018

Denied headache, chest pain, nausea / vomiting. If this patient had chest pain and the value suggested early repol, I would be very hesitant to act on it. ACTUAL CORONARY ANATOMY: Dominance: Right LM: A 5 mm vessel which bifurcates into the LAD and LCx coronary artery. Ambulated to ambulance for eval.

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STEMI Chest Pain RN Anatomy 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Case A 39-year-old male without prior medical history presents with chest pain that started 2 hours prior to presentation. He says that the pain intensity was 10/10 at home but now about 4/10. Despite the clinical stability and decreasing pain, this patient needs an immediate angiogram. Here are his publications.)

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Myocardial Infarction Chest Pain Blog Echocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. The day prior to presentation (about 12 hours prior to presentation) he described sudden onset chest pain and shortness of breath while gardening in his back yard. He had no further pain and went to bed that night with no complaints.

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