Frontiers in Cardiovascular Medicine

DECEMBER 19, 2023

Idiopathic pulmonary aneurysm is a clinically rare condition characterized by an unknown etiology and episodic occurrence. Despite its rarity, idiopathic pulmonary artery aneurysm poses potential risks to patients. Subsequently, she underwent surgical treatment.

Aneurysm 64

Aneurysm Pulmonary Chest Pain 64

Dr. Smith's ECG Blog

MAY 18, 2011

A 29 year old male presented with 6 hours of stuttering chest pain, constant for the last hour, worse with breathing. Take home point here : Obtain an ECG on anyone with chest pain. He had no medical history. What is the diagnosis? Sometimes you will find an obvious STEMI. He has persistent ST elevation.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Aneurysm 52

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

LV aneurysm has QS-waves, so this couldn't be LV aneurysm, right? RBBB makes it mandatory that there are R'-waves even in the presence of LV aneurysm. Additionally, it is very difficult to differentiate subacute reperfused OMI from LV aneurysm: both have Q-waves and inverted T-waves. This is HIGHLY suspicious for OMI.

Aneurysm 124

Aneurysm Stent Stents Chest Pain 124

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. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

Submitted and written by Anonymous, edits by Meyers and Smith A 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache. Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 mg/dL, K 3.5

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Journal of Cardiothoracic Surgery

FEBRUARY 3, 2024

Sinus of Valsalva aneurysm (SVA) is an extremely rare condition, and its rupture causes acute symptoms such as chest pain and dyspnea. Ruptured SVA is frequently associated with other congenital defects.

Aneurysm 52

Aneurysm Chest Pain Congenital 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Isn't it amazing?? hours earlier? Don’t Ignore Bedside Echo Results! —

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

The medics stated he had been nauseated and diaphoretic, but he did not have any chest pain or SOB. The only alternative is old inferior MI with persistent ST-Elevation, or inferior aneurysm morphology. Unlike anterior aneurysm, a QS-wave is uncommon. Unlike anterior aneurysm, a QS-wave is uncommon.

Aneurysm 115

Aneurysm Chest Pain Echocardiogram STEMI 115

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

An elderly woman presented with chest pain that radiated to the back for several hours. The first troponin returned at 0.099 ng/mL (elevated, consistent with Non-Occlusion MI) Providers were concerned with aortic dissection, so they order a chest aorta CT. Here is here initial ECG: There is only a nonspecific flat T-wave in aVL.

Chest Pain 52

Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). The patient was still with ongoing chest pain at the time ECG #1 was done.

Chest Pain 52

Chest Pain STEMI Aneurysm Pericarditis 52

Dr. Smith's ECG Blog

NOVEMBER 17, 2014

This case was recently posted by Tyron Maartens on Facebook EKG club (he agreed to let me post it here), with the following clinical information: "42 year old male with two weeks of intermittent chest discomfort, awoke 4 hours prior to this ECG with a more severe, heavy chest pain (5/10). BP 112/80, SpO2 100%. It is not chronic.

Aneurysm 52

Aneurysm STEMI Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

NOVEMBER 10, 2008

70 yo with h/o MI, recent CABG, has acute onset of chest pain. The differential is wider, however, and mostly includes "old MI with persistent ST elevation," otherwise known as "left ventricular aneurysm morphology". in acute MI, and almost always lower in LV aneurysm. What is the most likely diagnosis?

Aneurysm 52

Aneurysm Chest Pain 52

Journal of Cardiothoracic Surgery

OCTOBER 7, 2024

A 54-year-old female presented with recurrent abdominal pain and new onset chest pain. Chest computed-tomography angiogram detected a thoracic aortic aneurysm with suspected Type A intramural hematoma (IMH) versu.

Chest Pain 52

Chest Pain Aneurysm Aortic 52

Dr. Smith's ECG Blog

JULY 31, 2013

A 20-something male presented from an outside facility with Chest pain. He came with this ECG from the outside facility, recorded 1 hour after pain onset: There is at least 2 mm of inferior ST elevation, with reciprocal ST depression in aVL, ST flattening in V4-V6, and T-wave inversion in V2. A coronary aneurysm was found.

Chest Pain 52

Chest Pain Aneurysm STEMI Ischemia 52

Heart BMJ

AUGUST 14, 2024

Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.

Aneurysm 52

Aneurysm Chest Pain Myocardial Infarction Thrombosis 52

Dr. Smith's ECG Blog

APRIL 12, 2013

He had no chest pain. The computer read is: **Acute MI ** The protocol for prehospital activation in the EMS system that this patient presented to requires 2 elements: 1) Chest pain 2) A computer read of **Acute MI ** Only 1 of 2 was present, so there was no prehospital activation. The patient was transported to the ED.

STEMI 52

STEMI Pulmonary Stent Stents 52

Heart BMJ

SEPTEMBER 25, 2024

The patient reported no chest pain or shortness of breath. Cystic formation of the foramen ovale Aortic sinus aneurysm Left. Clinical introduction A woman is her 60s with no medical history presented to the hospital with palpitations and occasional nausea. Observations revealed a normal temperature of 36.5°C

Atrial Flutter 52

Atrial Flutter Chest Pain Blood Pressure Aneurysm 52

Frontiers in Cardiovascular Medicine

JULY 2, 2024

During this procedure, the patient experienced discomfort, such as chest pain and palpitations, but these symptoms disappeared when procedure completed.

Chest Pain 52

Chest Pain Pulmonary Aneurysm 52

Dr. Smith's ECG Blog

JULY 3, 2018

Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. The pain initially started the day prior to presentation. The ST elevation from today is ~0.2

Pericarditis 52

Pericarditis Chest Pain Stent Stents 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chest pain. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded.

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 2 , EKG 1: What do you think?

Chest Pain 116

Chest Pain STEMI Echocardiogram Stent 116

Dr. Smith's ECG Blog

JANUARY 31, 2020

Although diagnostic of MI, it is highly suspicious for " Old inferior MI with persistent ST Elevation" or "inferior aneurysm morphology" because of the well-formed Q-waves and the flat T-waves. To repeat: in contrast, anterior aneurysm is much more easily distinguished from acute MI due to the QS-waves. There are well-formed Q-waves 3.

Angina 52

Angina Stent Stents Aneurysm 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. See more such cases of RBBB with LV aneurysm here.

Aneurysm 66

Aneurysm Chest Pain Cardiogenic Shock Blog 66

Dr. Smith's ECG Blog

JULY 26, 2023

But the well-formed Q-wave and the presence of a normal T-wave in inferior leads led me to believe this was Old Inferior MI with persistent ST Elevation, otherwise known as inferior LV aneurysm. Anterior LV aneurysm is much easier to recognize because the Q-wave is usually a QS-wave (no R-wave at all), in at least one lead.

Aneurysm 52

Aneurysm Chest Pain STEMI Bradycardia 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

Persistent ST elevation 3 days after a nearly transmural MI portends possible LV aneurysm. This 42 yo diabetic male presented with cough and foot pain. Symptoms have been prolonged but intermittent, and there has been little chest pain, if any. He had been awakened by cough at 3 AM 2 days earlier.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

MARCH 11, 2019

The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." At some point he returned with chest pain, and all these findings were put into place. Many MI do not have chest pain 4. He was discharged and returned again.

Chest Pain 52

Chest Pain Ischemia Aneurysm Myocardial Infarction 52

Dr. Smith's ECG Blog

JUNE 18, 2011

3 hours prior to calling 911 he developed typical chest pain. The old ECG has a Q-wave with persistent ST elevation in lead III, and some reciprocal ST depression (typical for aneurysm morphology). This is "Persistent ST elevation after previous MI" or "LV aneurysm morphology".

STEMI 52

STEMI Pericarditis Hospital Aneurysm 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

Written by Pendell Meyers, edits by Steve Smith A man in his 60s with history of hypertension and MI 10 years ago, with PCI, presented to an outside hospital complaining of chest pain that started while mowing the lawn. TOP Initial ECG of this 60-year old man with a history of prior MI, who presented with new-onset chest pain.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours.

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

JANUARY 28, 2023

Case 1 A middle aged woman presented with acute chest pain and shortness of breath, unclear time since onset, and likely with episodic symptoms off and on throughout the day. QS waves from V2-V5 consistent with LV aneurysm morphology. Submitted by anonymous, written by Pendell Meyers. Additional case by Smith.

STEMI 52

STEMI Chest Pain Stent Stents 52

Circulation

NOVEMBER 11, 2024

Subsequently, he developed chest pain with hypotension, diffuse ST elevations on ECG, and hsTropI of 638 ng/L. Cervical adenopathy and hepatitis are more common in adults while coronary artery aneurysms are rarer. Labs include WBC count 13320/cmm with 85% neutrophils, total bilirubin 13.1 mg/dL, direct bilirubin 9.3

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Aneurysm Circulation 40

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

He denied fevers and chills, abdominal pain, chest pain, or SOB. This may be permanent and may be associated with echocardiographic dyskinesis (aneurysm). LV aneurysm is common in completed, full thickness (transmural) MI, which is what we have here. Patient stated his dry weight is around 85 kg.

Aneurysm 52

Aneurysm Ischemia Embolism STEMI 52

DAIC

SEPTEMBER 4, 2024

This can lead to complications such as blocked, reduced, or backward blood flow through the heart chambers, causing shortness of breath, chest pain, fainting, and difficulty exercising. In more severe cases, the disease can lead to an aortic dissection, or tear in the aorta, a life-threatening condition.

Aortic valve 52

Aortic valve Bicuspid/Mitral Aortic Research 52

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. The LV aneurysm morphology persists. The patient was sent home with a prescription for omeprazole to treat presumed peptic disease. He spent the following weeks with continued episodic heartburn and worsening dyspnea on exertion.

Outcomes 113

Outcomes Stenosis Outpatient Echocardiogram 113

Dr. Smith's ECG Blog

DECEMBER 29, 2015

What do you think of this ECG in a patient with chest pain? Case history A middle-aged woman with a history of HTN, but no prior CAD, presented to the ED with chest pain. The pain had been mild and intermittent for 2 weeks, but had become more intense on the night of presentation. Is the ST elevation due to LVH?

STEMI 40

STEMI Myocardial Infarction Chest Pain Aneurysm 40

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." Case 3 : Male in 30's with chest pain, cough, and fever. What do you think? EMS recorded the following ECG: What do you see?

STEMI 40

STEMI Chest Pain Cardiac Arrest Stent 40

Dr. Smith's ECG Blog

JULY 18, 2014

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. Additionally , these patients have a high incidence of LV aneurysm with mural thrombus. There was some SOB. He had walked into the ED (did not use EMS).

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52