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. I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion. This is a huge anterolateral OMI. I cannot be anything else.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. As discussed earlier — substitution in the chest leads with right-sided and posterior leads confirms RV and posterior MI. His prehospital ECG was diagnostic of inferior posterior OMI.

Chest Pain 74

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 74

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered.

Chest Pain 85

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 85

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.

Arrhythmia 108

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 108

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. A 50-something presented with s udden onset palpitations 8 hrs prior while sitting at desk at work. Patient intubated.

Tachycardia 132

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 132

Dr. Smith's ECG Blog

AUGUST 28, 2020

Bad chest pressure with severe left shoulder pain 3 nights ago. Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." Cardiogenic shock and ACS is an indication for the cath lab, even if you don't think there is OMI.

Cardiogenic Shock 52

Cardiogenic Shock Chest Pain Ischemia Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenic shock but awake. What is the Diagnosis in this 70-something with Chest Pain? 68 minutes with chest compressions, full recovery.

Cardiogenic Shock 52

Cardiogenic Shock Chest Pain Tachycardia Ischemia 52

Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. And she does not know that this is an overdose; she thinks it is a patient with chest pain!! Today's patient is a young male who presented in cardiogenic shock following a massive verapamil overdose. The initial K was 3.0

Cardiogenic Shock 79

Cardiogenic Shock Arrhythmia Blog Education 79

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chest pain. Vitals were HR 58 BP 167/70 R20 sat 96%.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 28, 2022

I’m an avid reader of your blog, and wanted your valued opinion on this. He went into cardiogenic shock and is intubated in the cardiac ICU. Both the patient and his wife attributed it to spicy food a couple hours prior, and I had to talk him in to being transported. Cortland : Thank you so much for your reply!

Chest Pain 52

Chest Pain Myocardial Infarction Pacemaker Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. His included cardiogenic shock, V Tach, AV block.

Aneurysm 68

Aneurysm Chest Pain Cardiogenic Shock Blog 68

Dr. Smith's ECG Blog

OCTOBER 26, 2010

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chest pain. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. He had this ECG recorded. Are the lungs clear?

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

Dr. Smith's ECG Blog

NOVEMBER 16, 2010

This 51 yo male complained of chest pain, then had a v fib arrest. He was in cardiogenic shock. The patient died 8 hours later of cardiogenic shock. Here are more examples of wide complex tachycardia: these are all a mix of ventricular tachycardia and SVT with aberrancy.

Tachycardia 52

Tachycardia Cardiogenic Shock Chest Pain STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

Just the fact of chest pain and highly elevated troponin is enough to activate the cath lab, but here you can see just how subtle hyperacute T-waves can be. 2) Typical persistent chest pain with a sigificantly elevated troponin is OMI until proven otherwise, regardless of the ECG.

Pulmonary 92

Pulmonary Tricuspid Chest Pain Cardiogenic Shock 92

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Case submitted by Rachel Plate MD, written by Pendell Meyers A man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He was in cardiogenic shock requiring an impella for several days after cath. But we should not be surprised.

Chest Pain 52

Chest Pain Cardiac Arrest Cardiogenic Shock Heart attacks 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician.

Ischemia 103

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 103

Dr. Smith's ECG Blog

APRIL 24, 2020

A middle aged man had off and on chest pain for 2 weeks, then 2 hours of more severe and constant pain. Just prior to transport, the patient became confused and agitated and, although blood pressure and pulse were OK, I was worried about cardiogenic shock. He did not get prehospital activation. What do you think?

Ischemia 52

Ischemia Chest Pain Stenosis Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 12, 2018

Wellens' is a syndrome of a painless period following an anginal (chest pain) event. When there is tachycardia, the patient is in cardiogenic shock with very poor LV function on bedside echo. We hope you can see the difference: See these cases for more examples: Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

Chest Pain 52

Chest Pain Pulmonary Embolism Tachycardia 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. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1.

Ischemia 52

Ischemia STEMI Stenosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

JULY 14, 2010

A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. She arrived comatose and in cardiogenic shock and the following ECG was recorded. Before EMS arrived, she had "seizure activity" and became unresponsive. She was intubated.

Cardiac Arrest 52

Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator 52

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). But the History in today's case was acute shortness of breath with dizziness and lightheadedness — and, essentially without chest pain! Additionally, there is borderline right axis deviation.

Cardiogenic Shock 105

Cardiogenic Shock Ultrasound Pulmonary Tachycardia 105

Dr. Smith's ECG Blog

MARCH 30, 2014

My most talented blog readers are paramedics because they have to put themselves on the line every time they activate the cath lab. Then the notes mention "cardiogenic shock" but without any reference to a cardiac echo or to a chest x-ray. Now chest pain free. And they teach me a lot.

Outcomes 52

Outcomes Cardiogenic Shock STEMI Chest Pain 52

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain?

Cardiogenic Shock 108

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 108

Dr. Smith's ECG Blog

JULY 18, 2014

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur.

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

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. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

Ischemia 52

Ischemia Cardiogenic Shock Aortic Stenosis 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He was asked multiple times about chest pain or dyspnea, but repeatedly denied any such symptoms. Patient denied chest pain on initial review of symptoms. Was now endorsing chest pain which began 30 minutes ago. Upon further questioning, he states that he has had intermittent chest pain since yesterday.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

And some similar ECGs from Pulmonary Embolism: A young woman with altered mental status and hypotension An elderly woman transferred to you for chest pain, shortness of breath, and positive troponin - does she need the cath lab now? Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology.

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

This was my response: If it is the right clinical situation, such as acute chest discomfort, it looks like proximal left anterior descending occlusion with right bundle branch block and left anterior fascicular block. Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock.

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 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?

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52