Dr. Smith's ECG Blog

AUGUST 30, 2023

Case sent by Logan Stark MD, written by Pendell Meyers A woman in her 70s presented with acute chest pain. Or perhaps the group beating is simply the result of sinus arrhythmia that by chance results in alternating R-R intervals of very similar size? No prior ECG was available. Here is her triage ECG: What do you think?

Chest Pain 71

Chest Pain Blog Arrhythmia STEMI 71

Dr. Smith's ECG Blog

JUNE 17, 2018

A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. Inclusion criteria were chest pain, at least 2 serial cTnI in 24 hours, sinus rhythm , and at least 1 ECG.

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Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 8, 2019

A previously healthy middle-aged male presented shortly after the acute onset of chest pain very shortly before calling 911. On arrival, he was pain free: What do you think? Jerry Jones commented: "Any ST depression on the ECG of a patient with chest pain credible for ACS represents a reciprocal change until proved otherwise."

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Chest Pain STEMI Plaque Ischemia 52

Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. There’s sinus arrhythmia with normal conduction, normal axis and normal voltages. Here’s the EMS ECG, digitized with PM cardio. What do you think? There’s loss of R waves in V2-3 with hyperacute waves V1-5.

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Chest Pain STEMI Blog Arrhythmia 66

Dr. Smith's ECG Blog

MARCH 1, 2023

Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms. During active chest pain an ECG was recorded: Meyers ECG interpretation: Sinus tachycardia, normal QRS complex, STD in V2-V6, I, II, III and aVF.

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Chest Pain Ischemia Stenosis Tachycardia 52

Dr. Smith's ECG Blog

JUNE 6, 2023

A 50-something presented with acute chest pain. MY Thoughts on today’s “quick-look ECG” are the following: There is sinus arrhythmia. Here is her ED ECG. It was texted to me while I was out and about. He wrote: "Steve, what do you think about hyperacute T waves in this? 54-year-old female with CP. What do you think, Dear Reader?

Chest Pain 52

Chest Pain Blog Arrhythmia 52

Dr. Smith's ECG Blog

JUNE 5, 2024

The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder.

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Chest Pain Blog Cardiac Arrest Cardiomyopathy 122

Dr. Smith's ECG Blog

APRIL 22, 2019

The computer called it a normal ECG Algorithm unknown Aside : [There is some "sinus arrhythmia", which is indeed a normal finding. Sinus arrhythmia is sinus rhythm whose rate varies with respiration. If the longest P-P interval is 120 ms greater than the shortest, it is sinus arrhythmia. Burning pain subxiphoid and into throat."

Chest Pain 52

Chest Pain Arrhythmia Ischemia STEMI 52

ECG Guru

JULY 26, 2023

Currently, he has no complaints: no palpitations, no shortness of breath, no syncope, no chest pain. There is a non-respiratory sinus arrhythmia present, which is essentially the minimal variant of a sick sinus syndrome. This is the ECG of an 81-year-old man with hypertension.

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Arrhythmia Chest Pain Hypertension 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

OCTOBER 13, 2022

Written by Jesse McLaren, with edits from Smith and Grauer A 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. Unfortunately, the reality is — that many ( most ) WPW patients who present with chest pain do not manifest intermittent preexcitation.

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Chest Pain Myocardial Infarction Ischemia STEMI 52

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

Dr. Smith's ECG Blog

MARCH 31, 2023

It is from a 50-something with chest pain: What do you think? In my opinion — AI is not yet "there" with regard to interpretation of complex cardiac arrhythmias. I like to start my ECG assessment in patients with new chest pain by looking for at least 1 or 2 leads that I know are definitely abnormal.

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Chest Pain STEMI Blog Academic 52

Dr. Smith's ECG Blog

JULY 5, 2023

The patient has acute chest pain. Instead — my thoughts were as follows: The rhythm is sinus , with marked bradycardia and a component of sinus arrhythmia. Tall R wave in lead V1 and/or early transition in the chest leads ( reflecting increased "septal" forces ). WPW Cardiac arrhythmias ( especially AFib ).

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Chest Pain STEMI Congenital Heart Disease Heart Disease 52

Dr. Smith's ECG Blog

JULY 30, 2023

Written by Pendell Meyers A woman in her 50s presented with acute chest pain and lightheadedness since the past several hours. For our readers who enjoy the challenge of interpreting cardiac arrhythmias — today’s case offers a “gold mine” of PEARLS regarding the recognition of AV Wenckebach.

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Chest Pain Ischemia STEMI Arrhythmia 52

Dr. Sanjay Gupta

AUGUST 31, 2022

The word arrhythmia comes from two Greek words. So arrhythmia literally means absence or loss of rhythm. A cardiac arrhythmia therefore means loss of cardiac rhythm. These include breathlessness, chest pain, dizziness or even blackouts. appeared first on Dr Sanjay Gupta Cardiologist.

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Arrhythmia Dysrhythmia Heart Rhythm Chest Pain 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

In the evening, a middle-aged man complained of chest pain at the nursing home. His chest pain was vague. He mentioned "cancer" and "chest". I’ll focus my comments on arrhythmia diagnosis. P EARL # 2 : In my experience — the most commonly overlooked arrhythmia ( by far! ) Fluids were started.

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Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

AUGUST 28, 2020

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. This should include details regarding the dosing regimen — the nature of the ventricular arrhythmia being treated — and the patient’s “baseline” QTc at steady state for his/her current Sotalol dose.

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Cardiogenic Shock Chest Pain Ischemia Stenosis 40

ECG Guru

JULY 26, 2023

Currently, he has no complaints: no palpitations, no shortness of breath, no syncope, no chest pain. There is a non-respiratory sinus arrhythmia present, which is essentially the minimal variant of a sick sinus syndrome. This is the ECG of an 81-year-old man with hypertension.

Chest Pain 52

Chest Pain Arrhythmia Hypertension 52

Ken Grauer, MD

OCTOBER 13, 2023

She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. With P waves labeled — Isn't it now much easier to appreciate that the atrial rhythm is quite regular ( with no more than a slight sinus arrhythmia )? For those with a special interest in cardiac arrhythmias — READ ON! —

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Blog Arrhythmia Bradycardia Download 159

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. Of academic interest — are the arrhythmias that developed.

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Tachycardia Chest Pain Academic Arrhythmia 132

Frontiers in Cardiovascular Medicine

JULY 16, 2024

BackgroundAmiodarone is a class III antiarrhythmic drug that is commonly used in the clinic to treat ventricular arrhythmias and atrial fibrillation. Despite normal annual check-ups, she developed abnormal liver and thyroid function tests, and imaging revealed lung and liver changes suggestive of amiodarone toxicity.

Chest Pain 52

Chest Pain Atrial Fibrillation Arrhythmia Pulmonary 52

Ken Grauer, MD

MAY 28, 2024

Note the Timed Contents that I detail below facilitate finding specific material. == ECG Podcast #4 — All About Comparison ECGs for 12-Leads and Arrhythmias ( Comparing ECGs seems so "easy" to do — but so often is not done correctly! ) — published by Mayo Clinic CV Podcast Series on 5/21/2024 ( 35 minutes ). What are the problems?

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Blog Arrhythmia Tachycardia CME 143

DAIC

JUNE 19, 2024

Patients may feel a fluttering in the chest, chest pain, shortness of breath and dizziness or lightheadedness as a result. It represents a unique opportunity to advance our therapy to the next level and potentially be able to treat patients with ventricular arrhythmias in a better way, without destroying healthy heart tissue.

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Tachycardia Cardiac Arrest Ablation Research 128

Dr. Smith's ECG Blog

JULY 24, 2024

And regarding arrhythmias: For more on the regular WCT — See My Comment in the May 5, 2020 post and in the April 15, 2020 post in Dr. Smith's ECG Blog. 11:35 — My views on: Will the computer ever be able to interpret complex arrhythmias? 14:45 — Using my definition — Are YOU an “ expert ” ECG interpreter? What are the problems?

Arrhythmia 52

Arrhythmia Blog Tachycardia CME 52

DAIC

JANUARY 18, 2024

We have long known that pulsed field ablation could open up an entirely new frontier in how we treat people battling the most complex cardiac arrhythmias. In addition to upcoming procedures in markets across Asia Pacific and Europe, Abbott anticipates approval for its U.S. chief medical officer of Abbott's electrophysiology business.

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Heart Rhythm Ablation AFIB Chest Pain 105

Dr. Smith's ECG Blog

MAY 27, 2012

A 90 yo with a history of orthostatic hypotension had a near syncopal event followed by chest pain. Chest pain was resolved upon arrival in the ED. Idioventricular rhythm is a common "reperfusion arrhythmia." Exactly how they relate to ischemia, chest pain, and reperfusion can only be speculated about.

Chest Pain 52

Chest Pain Ischemia Dysrhythmia STEMI 52

Dr. Smith's ECG Blog

JULY 25, 2024

Just as important is pretest probability: did the patient report chest pain prior to collapse? After cardiac arrest, I ALWAYS wait 15 minutes after an ECG like this and record another. The ST depression usually resolves, or is clearly resolving (getting much better). Then assume there is ACS.

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Cardiac Arrest Ischemia Tachycardia Defibrillator 124

Circulation: Arrhythmia and Electrophysiology

DECEMBER 21, 2023

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59–1.61];P=0.92) Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02)

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Atrial Fibrillation Ablation Chest Pain Atrial Flutter 40

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Electrocardiogram in clinic showed sinus arrhythmia with early repolarization and no ischemic changes. Treadmill exercise stress test showed excellent functional capacity without exercise-induced chest pain or ischemic ECG changes. Invasive coronary angiography ruled out luminal narrowing or dynamic compression.

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Chest Pain Exercise Echocardiogram Electrocardiogram 59

Ken Grauer, MD

APRIL 23, 2023

No chest pain. In a previously healthy adolescent ( who is 15 years old in today's case ) — the presentation of an acute febrile illness that is without a complaint of chest pain, is highly unlikely to be due to an acute MI. He was hemodynamically stable. How would YOU interpret the ECG in Figure-1 ?

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Blog Chest Pain Arrhythmia Download 78

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 was seen immediately after patient 1 by the same cardiologist.

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Chest Pain STEMI Echocardiogram Stents 116

MIBHS

JULY 31, 2024

Arrhythmias (Abnormal Heart Rhythms) Stress hormones can disrupt the signals that regulate your heartbeat, leading to arrhythmias – abnormal heart rhythms that cause your heart to beat too fast, too slow, or irregularly.

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Blood Pressure Heart Attack Heart attacks Heart Rhythm 52

Dr. Smith's ECG Blog

JULY 16, 2024

This is the prehospital ECG from an 81 year old man with acute chest pain. Arrhythmia? Today’s case recalled that scenario for me, in that it features recognition of an arrhythmia that fooled ED staff into thinking the ECG was showing an acute infarction. The medics did NOT activate the cath lab. Would you give lytics?

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Atrial Flutter Chest Pain Tachycardia Arrhythmia 59

Ken Grauer, MD

JANUARY 26, 2023

The ECG in Figure-1 was obtained from a previously healthy older man — who complained of chest pain and “lightheadedness” while this tracing was recorded. His chest pain had begun the night before. Figure-1: 12-lead ECG and long lead II rhythm strip — obtained from an older man with chest pain and “lightheadedness. (

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Blog Chest Pain STEMI Arrhythmia 78

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean.

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Stroke Strokes Chest Pain Cardiomyopathy 70

Ken Grauer, MD

FEBRUARY 18, 2023

The presenting complaint was chest pain — and the patient collapsed soon after arrival in the ED. C ASE F ollow- U p : As noted in today’s case presentation — this patient presented with chest pain, and then collapsed soon after the ECG in Figure-1 was obtained. Do YOU agree with this cardiologist ?

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Blog AFIB Chest Pain STEMI 78