Dr. Smith's ECG Blog

JUNE 19, 2024

Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. He described his chest pain as pleuritic and reported that it started the day prior while swinging a golf club. His pain suddenly became much worse in the ED and he became acutely diaphoretic, dizzy, and hypotensive.

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Chest Pain Pericarditis Pacemaker STEMI 60

Dr. Smith's ECG Blog

MAY 27, 2024

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chest pain as a “STEMI equivalent”[3] 3. ST depression in lead AVL differentiates inferior ST-elevation myocardial infarction from pericarditis.

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Chest Pain STEMI Myocardial Infarction Ischemia 119

ECG Cases

NOVEMBER 16, 2021

Jesse McLaren guides us through 9 cases and explains how pericarditis is a diagnosis of exclusion through 3 simple steps: 1. Exclude more serious causes of chest pain, eg wraparound LAD occlusion, inferior OMI 2. Exclude complications of pericarditis, eg myocarditis, large pericardial effusion 3.

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Pericarditis Chest Pain Blog STEMI 52

Dr. Smith's ECG Blog

APRIL 25, 2023

Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. First, many on Twitter said "Pericarditis". This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. Angiogram : "Acute onset chest pressure with diaphoresis." "ECG

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Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. This is OMI until proven otherwise.

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Chest Pain Ischemia Pericarditis Tachycardia 85

Dr. Smith's ECG Blog

MAY 16, 2023

Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chest pain". Acute pain?" -(Dr. I immediately responded: "cool fake!

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Chest Pain Pericarditis Tachycardia STEMI 52

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.

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Chest Pain STEMI Blog Pericarditis 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

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Chest Pain Blog Critical Care Arrhythmia 64

Dr. Smith's ECG Blog

AUGUST 4, 2024

Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. Pericarditis maybe." Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. Meyers' words — "is one of the rare ECGs that is actually specific for pericarditis".

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Pericarditis Chest Pain Blog Aortic 95

Dr. Sanjay Gupta

DECEMBER 19, 2022

Pericarditis refers to inflammation of the pericardium The pericardium is a sac within which the heart sits. Acute inflammation of this sac is known as acute pericarditis. About 5% of patients who present to A+E with chest pain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis.

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Pericarditis Heart Attack Heart attacks Chest Pain 40

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.

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Pericarditis Chest Pain Aortic Blog 52

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

SEPTEMBER 5, 2024

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). As already mentioned, this patient could have post-infarction regional pericarditis from a large completed MI. Sinus tachycardia has many potential causes. Hammill SC.

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Cardiogenic Shock Pericarditis Chest Pain Myocardial Infarction 103

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. PR depression, which suggests pericarditis 4. Here is that ECG: What do you think? There is sinus tachycardia.

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Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

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Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Upon questioning patient, he denies having any chest pain or chest tightness of any sort. Assessment:" " Nonspecific ST elevation from V1-V4 , question of early repolarization versus pericarditis , question of acute current of injury and ? Pericarditis would be even more unlikely in someone without chest pain.

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Chest Pain Coronary Artery Bypass Graft Pericarditis Blog 52

Dr. Smith's ECG Blog

DECEMBER 10, 2019

This is a previously healthy male teenager who was awoken by chest pain. The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain.

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Chest Pain Pericarditis Ischemia Pediatrics 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 felt nauseous and lightheaded with no neurologic deficits.

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Chest Pain Ischemia Aortic Aortic valve 52

Dr. Smith's ECG Blog

JUNE 20, 2018

A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to "both axilla" as well as the upper back. She was reportedly "pacing in her room while holding her chest". Clinician and EKG machine read of acute pericarditis.

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Pericarditis Chest Pain Blog Ultrasound 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. The ST elevation is far more prominent than the T-wave and this is what I see as the defining feature differentiating OMI from pericarditis.

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Pericarditis Chest Pain Bradycardia Aortic 84

Dr. Smith's ECG Blog

MARCH 26, 2024

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. Submitted by a Med Student, with Great Commentary on Bias!

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Chest Pain Embolism Pulmonary Ischemia 69

Dr. Smith's ECG Blog

JANUARY 10, 2020

He presented to the ED because he developed sudden severe, sharp, pleuritic (but not positional), substernal and left mid to lower chest pain. It could also be due to pericarditis or myocarditis, but I always say that "you diagnose pericarditis at your peril." Pericarditis? Learning Points: 1. What happens then?

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Chest Pain Pericarditis Ultrasound Download 52

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

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Chest Pain Embolism Pulmonary Tachycardia 137

Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). The patient was still with ongoing chest pain at the time ECG #1 was done.

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Chest Pain STEMI Aneurysm Pericarditis 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

days of chest pain that started as substernal and crushing in nature awakening him from sleep and occasionally traveling to right side of neck. The pain was described as constant, worse with deep inspiration and physical activity, sometimes sharp. He reported 1.5

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Pediatrics Pericarditis COVID-19 Congenital Heart Disease 112

Dr. Smith's ECG Blog

OCTOBER 17, 2022

In fact, there was no chest pain either. Pericarditis? If you were thinking that this is pericarditis, that would be possible in the absence of any clinical information. However, there is zero PR depression which would be VERY unusual in pericarditis. P.S.: Acute pericarditis may produce diffuse ST elevation.

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Pericarditis Chest Pain Blog Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 20, 2013

Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?

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Pericarditis Chest Pain Pulmonary Embolism 52

Dr. Smith's ECG Blog

AUGUST 24, 2012

A young otherwise healthy man presented with 4 hours of sharp 10/10 substernal chest pain. But there was some doubt as to whether it might be pericarditis because of the ST elevation in I and II, without ST depression in III. This is a good sign for myocardial infarction and does not happen in pericarditis. BP was 160.

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Pericarditis STEMI Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. A patient with OMI can have a totally normal ECG!"

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Myocardial Infarction Chest Pain STEMI Blood Pressure 121

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

Emre is a new Editor of the Blog. A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. You can find many examples on this blog attesting that. Written by Emre Aslanger.

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Chest Pain Myocardial Infarction Blog Pericarditis 52

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. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o.

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Chest Pain Myocardial Infarction STEMI Critical Care 113

Dr. Smith's ECG Blog

MARCH 3, 2023

Many researchers, including the editors of this blog, tried to develop such tools in the recent past and we have recommended their use in certain clinical scenarios in many posts on this blog. Recently, we published a structured approach to ECG diagnosis of OMI in the Archives of Turkish Society of Cardiology.

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Chest Pain STEMI Download Blog 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. Like other cases on this blog who died before cath was done, I cannot prove that this patient had OMI.

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Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Of course the patient was saddled with the erroneous "pericarditis" diagnosis after CTs ruled also ruled out PE and dissection. Both were awake and alert with normal vital signs. What do you think?

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STEMI Chest Pain Blog Pericarditis 116

Dr. Smith's ECG Blog

JANUARY 17, 2018

A physician caring for his new arrival, a 50-something with acute chest pain and dyspnea and syncope, texted me this initial ED ED ECG. ECG Diagnosis: Normal variant ST Elevation vs. Pericarditis. Uncertain whether there is pericarditis or normal variant. No active chest pain 2. What do you think?

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Pericarditis Chest Pain STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 12, 2023

Written by Pendell Meyers, edits by Smith Two patients presented with acute chest pain/pressure. Here is the South African Flag sign ( Figure by Ken Grauer — with the original 12-lead from Patient 1 attached below — See his Comment from the April 8, 2022 post in Dr. Smith's ECG Blog for more on this sign ).

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Chest Pain STEMI Blog Stenosis 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? Now another, with ultrasound.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52