Dr. Smith's ECG Blog

APRIL 8, 2022

There is a patient with persistent chest pain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chest pain patient. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Is there STEMI?

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Chest Pain SCAD STEMI Blog 52

Circulation

NOVEMBER 11, 2024

The patient’s chest pain (CP) was not alleviated with initial revascularization of his left circumflex (LCx) ST, requiring PCI to his right coronary artery (RCA) chronic total occlusion (CTO). Circulation, Volume 150, Issue Suppl_1 , Page A4137144-A4137144, November 12, 2024. We present a case of reinfarction from ST.

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Chest Pain Coronary Artery Disease Angioplasty Thrombosis 40

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o.

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Chest Pain Myocardial Infarction STEMI Pericarditis 115

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. The patient was transferred to CCU to consider surgical options.

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STEMI Chest Pain Myocardial Infarction Blog 120

DAIC

MAY 2, 2024

This causes angina, a type of chest pain which is characterized as refractory angina when this pain cannot be controlled by a combination of optimal medical therapy, angioplasty or bypass surgery, and is estimated to impact 600,000 to 1.8 million patients in the United States.

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Ischemia Angina Heart Failure Outcomes 95

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Marcus, G. Harvard Medical School, Boston, Massachusetts, USA. Metoprolol and atenolol are overwhelmingly beta-1 cardioselective. Beta-1 blockade decreases inotropy and chronotropy and has no vasoconstrictive effects. Only beta-2 blockade (e.g., Henry Ford Hospital. Henry Ford Hospital.

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Tachycardia Chest Pain Pharmacology Myocardial Infarction 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. Type B waves are deeper and symmetric. Wehrens X.H., Doevendans P.A., Ophuis T.J.,

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Chest Pain Myocardial Infarction Ischemia Angina 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.

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STEMI Chest Pain Myocardial Infarction Angioplasty 52

Ken Grauer, MD

MAY 20, 2023

NOTE: It's important to correlate ongoing circumstances at the time that a prior tracing was done ( ie, Was the patient stable and asymptomatic — or were they having chest pain, an exacerbation of heart failure, or some other ongoing process at the time the prior ECG was recorded? ).

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Blog Chest Pain Ischemia STEMI 145

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

All About Cardiovascular System and Disorders

JULY 21, 2024

This can block smooth flow of blood and the person can develop chest pain. When medications and/or procedures like balloon angioplasty are unable to re-establish good blood flow to the heart, these blood vessels can be bypassed by an operation known as coronary artery bypass grafting or CABG.

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Coronary Artery Bypass Graft Angioplasty Chest Pain Cardiac Rehabilitation 40

All About Cardiovascular System and Disorders

APRIL 17, 2024

As of now CT angiograms cannot replace conventional coronary angiography while planning procedures like balloon angioplasty. Balloon angioplasty is removal of blocks from the blood vessels using slender long tubes with high pressure balloons at the tip. CT coronary angiogram can be done as an outpatient test, in the X-ray department.

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Coronary Angiogram Catheterization Laboratory Angioplasty Chest Pain 40

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.

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Dr. Smith's ECG Blog

JUNE 18, 2013

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. Ann Emerg Med 1998;31(1):3-11. Wang T, Zhang M, Fu Y, et al.

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STEMI Chest Pain Myocardial Infarction Webinar 52

Dr. Smith's ECG Blog

APRIL 2, 2014

A male in his 60's called 911 for chest pain. His pain was intermittent and he was vague about when it was present and when it was resolved. The RCA was opened with POBA ("plain old balloon angioplasty") and eptifibatide was started. Here is his prehospital ECG: Diagnosis?

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STEMI Ischemia Chest Pain Angioplasty 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. There is no ST elevation.

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STEMI Ischemia Chest Pain Myocardial Infarction 52

DAIC

FEBRUARY 29, 2024

ET Murphy Ballroom 4 Health 360x Registry: Scalable Workforce for Equitable Access to Point of Care Decentralized Clinical Trials Prevalence of Cardiovascular Disease and Risk Factors Among National Football League Alumni and Their Family Members: Results from the Huddle Study Hózhó (Heart Failure Optimization at Home to Improve Outcomes): A Pragmatic (..)

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Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Ken Grauer, MD

APRIL 9, 2023

No chest pain. Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. What is the rhythm ?

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Blog Chest Pain Arrhythmia Cardiac Arrest 78

Dr. Smith's ECG Blog

FEBRUARY 10, 2023

That said, as per Dr. Smith — it should still be obvious in a patient with chest pain, that acute proximal LAD occlusion must be assumed until proven otherwise! I suspect that to a large extent — what is seen on ECG depends greatly on when during the process the ECG is obtained.

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STEMI Chest Pain Ischemia Angioplasty 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. The patient has a history of CABG so some of these changes could be old, but with ongoing chest pain and bradycardia in a high risk patient this is still acute OMI until proven otherwise. HR 40, BP 135/70, RR16, O2 100%.

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Chest Pain STEMI Bradycardia Myocardial Infarction 86

MIBHS

MARCH 31, 2025

Signs include: Sudden loss of consciousness No pulse or breathing Collapse without prior chest pain or discomfort If someone experiences sudden cardiac arrest, it is crucial to begin CPR immediately and call the local emergency number. Without prompt treatment, parts of the heart muscle may become damaged or die.

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Frontiers in Cardiovascular Medicine

APRIL 1, 2025

Interventional management involved performing percutaneous transluminal coronary angioplasty using balloon dilation on both the left main coronary artery and its ostium. Chest pain experienced under local anesthesia more directly suggests coronary occlusion.

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Aortic valve Aortic TAVR Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

A male in late middle age with a history of RCA stent 8 years prior complained of chest pain. See this article by Widimsky: Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy [link]

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Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

OCTOBER 22, 2024

He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. Successful primary angioplasty of the mid-circumflex artery towards the main marginal branch with the implantation of a drug-eluting stent. You must record frequent serial ECGs for patients with chest pain.

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Chest Pain STEMI Myocardial Infarction Angioplasty 65

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

No chest pain. His inpatient clinicians did not think that an urgent angiogram was warranted given that he was chest pain free, his EKG appeared nondiagnostic, and serial troponins were not elevating beyond 2 ug/L. The lesion was intervened on with balloon angioplasty and had subsequent TIMI 3 flow. Why is this?

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Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

MIBHS

SEPTEMBER 15, 2024

While men often report crushing chest pain as the most prominent symptom, women might experience subtler symptoms like shortness of breath, nausea, or back pain. Women might describe it as a tightness, pressure, or squeezing sensation rather than a sharp pain.

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Blood Pressure Heart Disease Chest Pain Coronary Artery Bypass Graft 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. Thanks for reading Dr. The data is overwhelming every way you can possibly look at it.

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Chest Pain Coronary Artery Disease Cancer Heart attacks 52

AMS Cardiology

OCTOBER 11, 2024

However, seeking immediate medical help is crucial if you experience chest pain, shortness of breath or dizziness. Procedures such as angioplasty, stenting and bypass surgery can restore blood flow to the heart and improve function. Early intervention can significantly improve outcomes and reduce the risk of complications.

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Heart Disease Heart attacks Heart Attack Diet 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Other cases of LAD OMI with RBBB/LAFB: A man in his 40s who really needs you to understand his ECG Cardiac Arrest at the airport, with an easy but important ECG for everyone to recognize A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia Ventricular Fibrillation, ROSC after perfusion restored by ECMO, then ECG.

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Chest Pain Cardiogenic Shock Tachycardia Ischemia 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. This is her ECG: An obvious STEMI, but which artery? Widimsky P et al.

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Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Wellnest

JULY 19, 2023

When a person experiences a heart attack or myocardial infarction, they may feel chest pain and other symptoms in different parts of their body. Although both techniques have advantages and limitations, primary angioplasty is the chosen therapy in most cases. So, how do you recognize a heart attack?

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Heart Attack Heart attacks Blood Pressure Myocardial Infarction 52

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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