Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. 1] European guidelines add "regardless of biomarkers". But only 6.4%

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STEMI Chest Pain Myocardial Infarction Blog 120

Dr. Smith's ECG Blog

JANUARY 5, 2024

Thus, the patient does not (yet) get a formal diagnosis of MI and must be called unstable angina unless further troponins return above the 99th percentile. The patient said his chest pain was 4/10, down from 8/10 on presentation. On the basis of unresolved angina, cardiology decided to perform rescue PCI. of the time.

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Angina Plaque Document Stent 119

Dr. Smith's ECG Blog

JULY 2, 2023

This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." Chest pain or discomfort) What do you think? The total duration of chest pain was 30-45 minutes.

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Chest Pain Angina Coronary Angiogram Blog 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. This is written by Willy Frick, an amazing cardiology fellow in St.

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Plaque Angina Blog Stent 126

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 81

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. mV compared to 0.05-0.1

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Pericarditis Chest Pain Stents Stent 52

Dr. Smith's ECG Blog

MARCH 9, 2013

This male in his 40's had been having intermittent chest pain for one week. He awoke from sleep with crushing central chest pain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. A stent was placed. Type B waves are deeper and symmetric. Lessons: 1.

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Chest Pain Myocardial Infarction Ischemia Angina 52

Circulation

NOVEMBER 11, 2024

Background:Although intracoronary acetylcholine (ACh) provocation testing is a guideline-recommended invasive standard for the diagnosis of vasospastic angina (VSA), ACh tests are largely underused in clinical practice globally. Circulation, Volume 150, Issue Suppl_1 , Page A4139995-A4139995, November 12, 2024. Recently, Rinaldi et al.

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Coronary Artery Bypass Graft Chest Pain Angina Cholesterol 40

Journal of Cardiovascular Electrophysiology

MARCH 11, 2024

Methods and Results A 67-year-old male with a history of LAAC was referred to our emergency room with recurrent chest pain and palpitations and was diagnosed with ischemic angina pectoris.

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Chest Pain Atrial Fibrillation Angina Stents 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Plan was for admission for chest pain workup. It was stented.

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Chest Pain Thrombosis Myocardial Infarction STEMI 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. BP was 160/100.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 10, 2023

A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.

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Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JULY 31, 2018

The lesion was stented. Prog- nostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pecto- ris-Myocardial Infarction Multicenter Investigators in Japan. It seems that there was some uncertainly about this. Int J Cardiol. 2016;207:341–348.

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SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

Delayed angiogram found a 95% mid RCA occlusion that was stented. Smith : this proves my impression that the inferior T-waves on the first ECG are hyperacute. Notice also that there is new T-wave inversion in III with upright T-wave in aVL, confirming inferior infarction.

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STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Paddy Barrett

DECEMBER 5, 2023

The logic of stenting obstructed coronary arteries is simple. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. But coronary stenting is not the only way to reduce symptoms of angina.

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Stents Stent Angina Heart Attack 59

DAIC

MAY 14, 2024

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death. Use Heart to Act on Angina. Available at: [link]. Accessed May 2024.

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Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. Repeat cardioversion was then s uccessful.

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Tachycardia Cardiogenic Shock Angina Blog 138

Dr. Smith's ECG Blog

MARCH 9, 2017

Case A 42-year-old lady presented to the ED with complaints of intermittent episodes of chest pain associated with shortness of breath for the last 2 days. This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. This case was written by Sam Ghali: ( @EM_RESUS ). Normal ECG.”

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Chest Pain Angina Ischemia Plaque 52

Dr. Anish Koka

MAY 16, 2023

This means that at every age, the probability a man complaining of chest pain has significant underlying coronary disease as a cause of this chest pain is much higher than a woman complaining of chest pain. The results of this dataset by age and gender follow.

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

It was stented. Therefore this is " Transient ST Elevation Unstable Angina." As there was ruptured plaque, this is NOT Prinzmetal's angina. Here are many other cases of Unstable Angina , in spite of Eugene Braunwald's Requiem for Unstable Angina. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, There was good flow.

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STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

MARCH 11, 2016

A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 It was treated with and dual "kissing balloons" and drug eluting stents. hours when she called 911. TIMI flow is 0. Door to balloon time was 51 minutes.

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Myocardial Infarction Pericarditis STEMI Angina 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. Beware crescendo angina in patient with known CAD ST Elevation in aVR Case 7.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Frontiers in Cardiovascular Medicine

MARCH 5, 2025

BackgroundPercutaneous coronary intervention (PCI) through the aorto-ostial coronary stent that is protruding into the aorta remains a technical challenge because of the poor coaxial alignment of the guiding catheter and the inability to advance the guidewire into the distal vessel through the stent's central lumen.

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Stents Stent Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 29, 2024

Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. So let's pretend this is acute chest pain. Was it unstable angina? Well, really, in this case, there was no angina, only "dizziness") I don't think so. What do you think?

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Stents Stent Chest Pain Angina 65

Dr. Smith's ECG Blog

APRIL 11, 2025

He then provided some history: " Classic story for angina, few hours of crushing chest pain." Here is the cath report (TIMI-2 flow in the circumflex -- stented): Learning Point: Just because the cardiologist says it is "not a STEMI" and "wants to teach you about the ECG", it does not mean you should back down.

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STEMI Angina Chest Pain Bradycardia 119

Dr. Smith's ECG Blog

FEBRUARY 8, 2025

Written by Jesse McLaren An 80 year old with a history of CHF, ESRD on dialysis, and multiple prior cardiac stents presented to the emergency department with 3 days of intermittent chest pain and shortness of breath that resolved after nitro, which felt like prior episodes of angina. What do you think?

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Chest Pain Stents Stent STEMI 63

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

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Chest Pain Ischemia Plaque Stent 62

Dr. Smith's ECG Blog

JANUARY 5, 2025

Written by Willy Frick A man in his 60s with hypertension and prior stroke presented with three days of crushing chest pain. He reported intermittent chest pain for the last few months, but never lasting this long. The cardiology consultant notes that pain is "almost resolved." There is active infarction.

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Chest Pain Ischemia Angina Echocardiogram 76

Dr. Smith's ECG Blog

APRIL 2, 2025

A 30 year old African American Male presented to the ED with chest pain that occurred the day before. There was no pain on the day of presentation. 2019.06.007) (Full text here: [link] ) The ECG above is diagnostic of Wellens' syndrome (full reference below): 1) Episode of anginal chest pain that is resolved (GONE!)

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Chest Pain STEMI Myocardial Infarction Stent 75