Anatomy Chest Pain STEMI 
Dr. Smith's ECG Blog
NOVEMBER 27, 2023
Written by Jesse McLaren A 45 year old presented with two weeks of recurring non-exertional chest pain, now constant for an hour. Because of the ECG changes in a patient with chest pain, and with inferolateral hypokinesis on POCUS, the cath lab was activated. Below is old and then new ECG (old on top; new below).
Dr. Smith's ECG Blog
APRIL 22, 2024
A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. At times the pain does go to his left neck. What do you think the prehospital ECG showed (with pain)?
Dr. Smith's ECG Blog
MARCH 22, 2024
Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. For national registry purposes, this will be incorrectly classified as a STEMI.) Most STEMI have peak cTnI greater than 10.0.
Dr. Smith's ECG Blog
JANUARY 9, 2023
No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. 50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. Pericarditis?
Dr. Smith's ECG Blog
JANUARY 23, 2023
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin.
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. Over the next few hours, four other general cardiologists "signed off on the initial ECG without recognizing STEMI." Learning Points: STEMI criteria misses 25-40% of OMI, like this case for example.
Dr. Smith's ECG Blog
NOVEMBER 28, 2018
A 50-something presented with epigastric and chest pain. Saddleback ST Elevation is almost never STEMI 2. Here are other cases of saddleback STE: Is this Saddleback a STEMI?? Here is his ECG: What do you think? QTc 388 ms. Saddleback STE may be type II Brugada syndrome 3. wave in V1?? wave in V1??
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