Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

A 60-something awoke with 10/10 crushing chest pain. I would expect that a stent would be placed. The angiogram showed an open artery with 95% stenosis and thrombosis and it was stented. But the patient's chest pain continues and so you order a 2nd ECG (ECG 2 here). He walked in to triage.

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Chest Pain STEMI Stents Stent 98

Ken Grauer, MD

OCTOBER 25, 2024

P.S.: Cardiac cath was performed — and showed a distal LA D "culprit" lesion that was successfully stented. The following are the KEY clinical and ECG features that establish the diagnosis of W ellens ' S yndrome : There should be a history of prior chest pain that has resolved at the time the defining ECG is obtained.

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Blog Chest Pain STEMI Cardiogenic Shock 94

Dr. Smith's ECG Blog

MARCH 27, 2025

After only 90 minutes of chest pain, the first troponin was unsurprisingly in the normal range at 11ng/L (normal <26 in males and <16 in females), so the emergency physician waited for repeat troponin. Chest pain still persists. Paged cardiology 0800: patient complains of chest pain. Cardiology aware.

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STEMI Chest Pain Pericarditis Ischemia 80

Dr. Smith's ECG Blog

JUNE 11, 2024

Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Chest pain and a computer ‘normal’ ECG.

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Chest Pain STEMI Blog Exercise 113

Dr. Smith's ECG Blog

JANUARY 31, 2020

The patient's chest pain had resolved by the time of the ECG 2. But it does prove that the patient has coronary disease and makes the probability that his chest pain is due to ACS very very high. Angiogram: Widely patent RCA and LAD stents. Therefore, no stent was placed. (No There are well-formed Q-waves 3.

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Angina Stents Stent Aneurysm 52

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. At that visit the patient was found to have an in-stent RCA occlusion. The patient was referred emergently to the cath lab, and again there was an in-stent RCA occlusion. What do you think? Troponin I peaked at 18.323ng/L.

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Chest Pain Pacemaker Ischemia Stents 111

Dr. Smith's ECG Blog

OCTOBER 6, 2024

This patient had the onset of chest pain 24 hours before arrival to the ED. The door to balloon time was incredibly short and there was a 100% circumflex occlusion that was opened and stented. I described "Posterior Reperfusion T-waves" in this article. Here is that ECG: Original ECG What do you think?

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Hospital Chest Pain Blog Pulmonary 77

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. EMS gave 324 mg aspirin and 3 sublingual NTG, which the patient stated reduced the substernal chest pain from an 8/10 to 4/10. The ECG only tells you there is ischemia, not the etiology of it.

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Echocardiogram Ischemia Chest Pain Blog 52

Dr. Paddy Barrett

AUGUST 1, 2023

This article is part 2 of a series on cardiac CT. If you have not yet read it, I suggest doing so before reading the remainder of this article. I've included the article here. Regardless, if you present with chest pain and get a stress test instead of a CTCA, you are arguably getting an inferior test.

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Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 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.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

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

JUNE 12, 2017

This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chest pain. link] Here is the history: A 30 yo man presented complaining of severe chest pain.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

She went on to describe her chest pain as a "buffalo sitting on my chest" and a "weird" sensation in her jaw for 1 hour prior to arrival, associated with lightheadedness and diaphoresis. The patient was given fentanyl initially for chest pain with minimal effect and then vomited which was followed by zofran and famotidine.

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Chest Pain Critical Care Article Pacemaker 52

Dr. Smith's ECG Blog

MAY 6, 2018

This 50-something otherwise healthy male presented with one hour of epigastric and lower chest pain. Here is an ECG with N-waves, from the article: Are these N-waves in our ECG? A 100% occlusion on of the circumflex, proximal to the first obtuse marginal, was found, opened, and stented. The cath lab was activated.

STEMI 52

STEMI Chest Pain Myocardial Infarction Stents 52

Dr. Smith's ECG Blog

JULY 31, 2018

Post by Smith, with short article by Angie Lobo ( [link] ), a third year intermal medicine resident at Abbott Northwestern Hospital Case A 30-something woman with no past history, who is very fit and athletic, presented with 1.5 hours of substernal chest pressure. The lesion was stented. She had zero CAD risk factors.

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SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 2, 2015

A middle-aged male called 911 for chest pain. Here was the first prehospital ECG with pain at 5/10: Computerized QTc is 418 ms. Formula value is now down to a very low value of 19.352 A 90% thrombotic LAD lesion was found and stented. There is nondiagnostic ST elevation in V1-V4. Most ST elevation is resolved.

STEMI 52

STEMI Myocardial Infarction Chest Pain Echocardiogram 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. She presented to the emergency department after a couple of days of chest discomfort. Many advances in treatment have occurred in the 28 years since this article was published. The last echocardiography 12 months ago showed HFmrEF.

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Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Case A 47 year old male called 911 for severe chest pain. It was opened and stented. A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chest pain with radiation to the anterior neck, with associated nausea. Culprit, stented) 3. He was clammy and looked unwell.

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Ischemia Chest Pain STEMI Stenosis 40

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

A 40 something otherwise healthy man presented with substernal chest pain. They were stented. As noted by Dr. Smith — the Am J Emerg Med article he cites above floats the notion that ECGs interpreted as "normal" by the computer "do not need to be overread by a physician". What do you think? Why not very very high?

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Chest Pain STEMI Article Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Case A 39-year-old male without prior medical history presents with chest pain that started 2 hours prior to presentation. He says that the pain intensity was 10/10 at home but now about 4/10. Despite the clinical stability and decreasing pain, this patient needs an immediate angiogram. Here are his publications.)

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Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Smith's ECG Blog

AUGUST 9, 2019

At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department Case 1. This is her ECG: An obvious STEMI, but which artery?

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Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. This was stented. However, this review references the Sterns article above, which by my reading does not state this. Most recent echo showed EF of 60%. He also had a history of chronic kidney disease, stage III. He had recently had a NonSTEMI. Crit Care Med.

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STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MAY 23, 2022

Patient 2 : 55 year old with 5 hours of chest pain radiating to the shoulder, with nausea and shortness of breath ECG: sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. This was missed by the treating physician, but the chest pain resolved with aspirin. This was STEMI(-)OMI.

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Chest Pain STEMI Pericarditis Arrhythmia 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. This article delves into heart attack symptoms, golden hour, treatment & prevention. The sooner you identify the symptoms, the quicker you can take action.

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Heart Attack Heart attacks Blood Pressure Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 19, 2025

Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. The patient has acute persistent refrectory chest pain and elevated troponin.

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Chest Pain STEMI Stents Stent 116

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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Stent Stents Chest Pain 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. See our article: Walsh, B., What do you think the prehospital ECG showed (with pain)? This male in his 40's had been having intermittent chest pain for one week.

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Chest Pain STEMI Myocardial Infarction Stents 76

Dr. Smith's ECG Blog

MARCH 8, 2025

After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA. 2:04 PM, post stent deployment You can see that even after complete restoration of flow, the ECG still looks terrible, V most of all.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

1) Very high initial troponin of 45,000 ng/L 2) A full day of chest pain 3) Q-waves on the ECG, with some T-wave inversion Here is one frame of the CT scan which includes the heart: Can you spot the infarct? It was opened and stented. SUBACUTE) OMI, that would result in an undesirable delay. How do I know?

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Blog Chest Pain Myocardial Infarction Critical Care 63