Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. A repeat ECG was recorded with pain 2/10: Not much change.

Chest Pain 52

Chest Pain STEMI Defibrillator Blog 52

Heart BMJ

JUNE 25, 2024

After 24 hours, the patient was readmitted to the hospital with chest pain and troponin elevation, without ECG changes. A transthoracic echocardiogram (TTE) revealed a mobile mass on the right coronary cusp of the aortic valve ( figure 1 , ). Figure 1 A mobile mass (1.88

Aortic valve 59

Aortic valve Aortic Chest Pain Atrial Fibrillation 59

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

Chest Pain 52

Chest Pain STEMI Blog Embolism 52

Dr. Smith's ECG Blog

MAY 20, 2024

A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.

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Chest Pain Blood Pressure Ischemia STEMI 125

Dr. Smith's ECG Blog

DECEMBER 14, 2016

A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. It was not relieved by anything. He had no previous medical history.

Chest Pain 52

Chest Pain STEMI Aortic Myocardial Infarction 52

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. It is essentially normal.

Chest Pain 52

Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She was taken immediately for a CT angiogram of the chest, abdomen and pelvis.

Chest Pain 40

Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

APRIL 9, 2023

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell Meyers A man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2024

Post op chest pain Typical of post-op pericarditis (postpericardiotomy syndrome) There is ST Elevation in II ＞ III, and STE in V3-5, but with flat T-wave. Angiogram: Severe 95% hazy distal LM Severe 80% ostial LAD, 100% occluded distal LAD thought to be due to distal embolization from the lesion in the proximal LAD.

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Pericarditis Chest Pain Bradycardia Aortic 104

Journal of Cardiothoracic Surgery

SEPTEMBER 19, 2024

Background Type A aortic dissection (TAAD) with coronary involvement is rare but potentially fatal. Case presentation Here, we describe a 52-year-old woman who presented with sudden chest pain. Proper myocardial protection during surgery is essential. CT angiography revealed TAAD with right coronary artery involvement.

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Aortic Chest Pain Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Left ventricular afterload reduction is essential to decrease the trans-se ptal pressure gradient and thus decrease shunt volume, making a larger proportion of the blood flow from the left ventricle through the aortic valve. Not all patients with acute ( or recent ) MI have chest pain with their event.

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Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

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

MAY 5, 2024

The provider had sent the patient for an aortic dissection scan which had shown extremely heavy calcification of the LAD. The patient had continued to have chest pain.

EKG Technician 124

EKG Technician Chest Pain Blog STEMI 124

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. They also wanted an aortic CT which was negative. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. What do you think the prehospital ECG showed (with pain)?

Chest Pain 115

Chest Pain Myocardial Infarction STEMI Pericarditis 115

AMS Cardiology

APRIL 16, 2024

If you’ve been diagnosed with aortic stenosis, you might have come across the term TAVR. Understanding Aortic Stenosis The aortic valve regulates blood flow from your heart’s main pumping chamber to the rest of your body. In aortic stenosis, the valve leaflets stiffen and narrow, restricting blood flow.

Aortic valve 40

Aortic valve TAVR Aortic Open-Heart Surgery 40

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

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Atrial Flutter Chest Pain Blood Pressure Aneurysm 52

Dr. Smith's ECG Blog

AUGUST 4, 2024

Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. Two weeks ago he had a significant MVC with many severe injuries, including aortic injury s/p endovascular repair. Smith responded: "Not OMI. Pericarditis maybe."

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Pericarditis Chest Pain Blog Aortic 116

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

SEPTEMBER 14, 2014

He presented with chest pain, not relieved by nitro, pain reproducible on exam and centered around the pacemaker insertion site. Here is his ECG one month prior, on admission for chest pain at that time also: Similar ratios. LV Ejection Fraction at the time of this hospitalization was 10%.

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Chest Pain Pacemaker Cardiomyopathy STEMI 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms.

Pericarditis 52

Pericarditis Chest Pain Aortic Blog 52

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

EMS 12-Lead

APRIL 9, 2024

There was no chest pain. V1 and V2 are probably placed too high on the chest given close morphological similarity to aVR. The fall was not a mechanical etiology. He denied any specific prodrome of gross palpitations, however did endorse feeling quite dizzy just before the event. Type II ischemia.

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Ischemia Stenosis Chest Pain Coronary Artery Disease 116

Dr. Smith's ECG Blog

MARCH 6, 2023

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation? However, in the context of the first ECG and the waning chest pain, this is diagnostic of reperfusion. Due to the severity of the pain and the high BP, they obtained an aortic dissection CT.

Chest Pain 52

Chest Pain STEMI Stenosis Blog 52

Circulation

NOVEMBER 11, 2024

Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations.

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Aortic valve TAVR Aortic Chest Pain 40

Dr. Smith's ECG Blog

JUNE 4, 2019

A 40-something woman presented to the ED having had “heartburn” overnight and then worsening chest pain 1 hour prior to arrival. Case continued The patient continued having pain. The patient arrived looking like an aortic dissection patient, so CTA was done and negative." The patient looked ill.

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Chest Pain STEMI Ischemia Aortic 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

All About Cardiovascular System and Disorders

MAY 1, 2024

Another important serious disease which has to be thought of in a person with pain in the chest or upper back is aortic dissection. Aortic dissection is tear in the inner lining of the aorta. Blood seeps into the wall of the aorta and spreads along the wall of the aorta.

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Blood Pressure Risk Factors Chest Pain Heart Attack 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

A 79‐year‐old man with a strong family history of arterial dissection, hypertension, coronary artery disease, and obesity experienced intense chest pain and left hemiparesis secondary to Type A aortic dissection with extension from the innominate artery to the right carotid bifurcation.

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Outcomes Chest Pain Coronary Artery Disease Aortic 40

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. Look at the aortic outflow tract. Aortic angiogram did not reveal aortic dissection. What do you see? Answer below in the still shot.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

JANUARY 3, 2022

This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chest pain. It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JUNE 28, 2019

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. There was concern for aortic dissection, so a CT was done and was negative. Time zero What do you think? There is inferior ST elevation. Is it normal variant? Is it ischemic (OMI)? Pericarditis?

Chest Pain 52

Chest Pain Pericarditis Stent Stents 52

EMS 12-Lead

JULY 24, 2023

But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chest pain was a little more intense, and the needed recovery period was longer in duration. Aortic Stenosis f. Aortic Stenosis [No Hx syncope, and no systolic murmur] f. Severe Hypoxia b.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

EMS 12-Lead

MAY 20, 2022

There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. As a brief review, HCM is a genetically inherited disorder that produces structural disarray in the myocardial cells.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Frontiers in Cardiovascular Medicine

APRIL 1, 2025

BackgroundFollowing transcatheter aortic valve replacement, acute coronary obstruction is infrequent but potentially life-threatening, while delayed coronary obstruction is even more uncommon.Case summaryA 69-year-old male underwent TAVR and subsequently developed an acute obstruction in the left main coronary artery.

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Aortic valve Aortic TAVR Chest Pain 52