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.

STEMI 52

STEMI Chest Pain Risk Factors Anatomy 52

Dr. S. Venkatesan MD

OCTOBER 31, 2024

Time window s for intervention for thrombolysis in STEMI starts from onset of chest pain, but when it comes to primary PCI, a different time window takes the center stage pushing the former to the background. How can we have uniform std of 90-120 minutes D2B in all STEMI cases ? Why is this disparity?

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STEMI Chest Pain Anatomy Thrombolysis 40

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??

STEMI 52

STEMI Chest Pain Cardiac Arrest Anatomy 52

Ken Grauer, MD

OCTOBER 21, 2023

Having looked for negative U waves in patients with chest pain over a period of decades — I'll emphasize that this is not a common finding. PEARL # 4: When the ECG changes evolve in a way that corresponds to the coming and going of chest pain symptoms — this is important information. BLUE arrows in Figure-2 ).

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Blog Chest Pain Ischemia STEMI 99

Dr. Smith's ECG Blog

AUGUST 28, 2020

This can only be due to STEMI. My THOUGHTS on ECG #1: We are told that the patient in today’s case had an episode of severe chest pain 3 nights prior to admission. Initial priorities in this patient were clearly to determine the anatomy — and reestablish coronary perfusion. I said "activate the cath lab."

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

Ken Grauer, MD

MARCH 7, 2023

But, in a patient who presents to the ED for new chest pain — seeing these subtle findings that are localized to leads V2- thru -V4 should at the least make you consider acute posterior OMI ( O cclusion-based MI ) — until you prove otherwise. To EMPHASIZE: These are subtle findings. What do YOU think?

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Blog Chest Pain STEMI Ischemia 78

Ken Grauer, MD

FEBRUARY 18, 2023

The presenting complaint was chest pain — and the patient collapsed soon after arrival in the ED. Looking at the location of ST elevation ( ie, in the inferior leads — and in V4,5,6 ) — and the location of ST depression ( ie, in leads I,aVL; V1,V2 ) — this ECG picture suggests an ongoing acute infero - postero - lateral STEMI.

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Blog AFIB Chest Pain STEMI 78

Dr. Smith's ECG Blog

FEBRUARY 14, 2020

Crushing Chest pain, but the ECG is not obvious; later there is both RBBB and LBBB 35 yo woman with LAD occlusion manifesting with only hyperacute Ts and inferior ST depression, also missed by computer The pain increased within the first 15 minutes and this repeat ECG was obtained: What is this?

Chest Pain 52

Chest Pain STEMI Anatomy Risk Factors 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.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

Dr. Smith's ECG Blog

AUGUST 9, 2018

Denied headache, chest pain, nausea / vomiting. Here it is: The computer reads STEMI What do you think? More from the medic: "LifePak 15 interpretation was STEMI. My response: "I think it is very worrisome for STEMI." It meets STEMI criteria even for a male under age 40, with STE 2.84 mm in V2 and 4.08

STEMI 52

STEMI Chest Pain RN Anatomy 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? aVR ST Segment Elevation: Acute STEMI or Not?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 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.)

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Written by Willy Frick A young woman with a history of paroxysmal nocturnal hemoglobinuria presented with acute substernal chest pain. Documentation does not indicate whether she had persistent chest pain during this time. Five days prior, she had a similar presentation to a different hospital.

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Chest Pain Hospital Anatomy Aneurysm 70