Circulation

NOVEMBER 11, 2024

Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing.

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Heart BMJ

JULY 25, 2024

1 However, with the introduction of high-sensitivity (hs) assays for cTn and the need for biomarkers for cardiovascular risk stratification, their use has expanded beyond the diagnosis of ACS. Cardiac troponin (cTn) plays a key role in diagnosing acute coronary syndrome (ACS) in the emergency department (ED).

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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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Dr. Smith's ECG Blog

DECEMBER 11, 2023

See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. This is different from nitroglycerin which produces vasodilation and can improve by pain improving myocardial perfusion. You do not need to be better than the Queen of Hearts at EKG to understand that refractory chest pain NEEDS CATH NOW.

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Dr. Smith's ECG Blog

DECEMBER 22, 2023

The patient with no prior cardiac history presented in the middle of the night with acute chest pain, and had this ECG recorded during active pain: I did not see any ischemia on this electrocardiogram. This is a case I had quite a while back. See the explainability : She sees large T-waves in V2, V3.

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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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CardiacWire

APRIL 24, 2024

One study revealed that a quarter of all ED visitors underwent a troponin test, even though less than half of them had chest pain. Another study showed that roughly one in seven ED patients had elevated troponin, even though they weren’t experiencing an MI, in part because troponin can be a sign of other non-coronary diseases.

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The British Journal of Cardiology

JUNE 11, 2024

Additionally, 2D transthoracic echocardiography (TTE), and myocardial injury serum biomarkers assays (creatine phosphokinase-MB [CPK-MB] and cardiac troponins [cTn]) were measured once. Cardiovascular consultation had been requested for all of the patients based on their primary clinical examination, vital signs, and electrocardiogram (ECG).

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Dr. Smith's ECG Blog

AUGUST 26, 2019

She did not report any chest pain or pressure. She was brought to the Emergency Department and this ECG was recorded while she was still feeling nauseous but denied chest pain, shortness of breath, or other symptoms: What do you think? A male in his 60s with chest pain A Male in his 60s with Chest pain.

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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. These patients have worse outcomes: higher mortality, more CHF, higher biomarkers, and worse ejection fractions than the NonSTEMI patients with open arteries. This patient had continued and ongoing pain.

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Dr. Anish Koka

JANUARY 1, 2023

The diagnosis was made based on classic findings of inflammation on an electrocardiogram associated with acute chest pain. 2-3 days after this he developed the same sharp chest pain and shortness of breath with elevated inflammatory markers (CRP) as well as typical findings of pericarditis seen on ECG.

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Dr. Anish Koka

FEBRUARY 6, 2023

Cardiac Cath labs waiting for some major influx of COVID heart damage not only didn’t see patients presenting with COVID heart attacks, but they idled as patients terrified of coming to the hospital stayed home rather than come to the hospital with chest pain. You could ignore the c19-myo without the conclusions changing much.

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Dr. Smith's ECG Blog

MARCH 2, 2009

Case 2 A 38 year old male with h/o smoking only c/o a few hours of severe substernal chest pain; he thinks he is having a heart attack. The pain is very nitroglycerine responsive. The first ECG with pain (unavailable) showed T wave flattening in V2 and V3. Fortunately, his MI was not large by biomarkers.

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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.

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Open Heart

OCTOBER 30, 2024

Background Elevated troponin levels are a sensitive biomarker for cardiac injury. The quick and reliable prediction of troponin elevation for patients with chest pain from readily available ECGs may pose a valuable time-saving diagnostic tool during decision-making concerning this patient population.

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Dr. Smith's ECG Blog

MAY 21, 2012

He presented with chest pain of 48 hours duration which became worse in the previous several hours. The pain was stabbing and 10/10 and associated with SOB. The pain was partly relieved with sublingual nitroglycerin. This patient had no significant past medical history.

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Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. Both reperfusion, as judged by the biomarker curve, and patency, as assessed by the angiogram, were correlated with the rapidity and depth of T wave inversion. He presented to the emergency department for evaluation. Below is his presentation ECG.

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Frontiers in Cardiovascular Medicine

DECEMBER 22, 2024

Novel serum biomarkers can potentially help in early detection and estimation of postoperative outcomes. BackgroundAcute aortic dissection is a lethal cardiovascular emergency; early diagnosis is critically necessary. ResultsYAP concentration was substantially elevated among ATAAD patients [3.45 (3.18, 3.63) vs. 2.44 (2.23, 2.59), P<0.01].

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Dr. S. Venkatesan MD

JANUARY 22, 2025

How can biomarkers help us grade these ACSs? I don’t understand how the curve of non-cardiac chest pain trespasses in the middle of a Troponin race (False positives? It is next to foolishness to rush them to cath lab. See how the Kaplans diverge dramatically depending upon the hsTnT levels.

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