Dr. Smith's ECG Blog

DECEMBER 14, 2022

Sent by Drew Williams, written by Pendell Meyers A man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin.

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Chest Pain STEMI Blog Stenosis 52

Dr. Smith's ECG Blog

MAY 20, 2024

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.

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Chest Pain Blood Pressure Ischemia STEMI 126

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

OCTOBER 24, 2019

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." A similar episode had occurred a week earlier during labor.

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Chest Pain SCAD STEMI Cardiogenic Shock 52

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.

Chest Pain 52

Chest Pain Ischemia Tachycardia Stenosis 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

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

APRIL 8, 2022

The ECG is diagnostic for acute transmural infarction of the anterior and lateral walls, with LAD OMI being the most likely cause (which has various potential etiologies for the actual cause of the acute coronary artery occlusion, the most common of which is of course type 1 ACS, plaque rupture with thrombotic occlusion). Is there STEMI?

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Chest Pain SCAD STEMI Blog 52

Dr. Smith's ECG Blog

MARCH 17, 2024

He also complained of intermittent mild chest pain radiating into into both shoulders and his back, as well as occasional unexplained sweating. ECG 1 Readers of this blog will have no trouble recognizing this as an OMI with some early reperfusion. He had no further chest pain. < 0.033). His ECG is shown.

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Angina Chest Pain Blog Ischemia 71

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. This is written by Willy Frick, an amazing cardiology fellow in St.

Plaque 127

Plaque Angina Blog Stents 127

Dr. Smith's ECG Blog

JULY 31, 2013

A 20-something male presented from an outside facility with Chest pain. He came with this ECG from the outside facility, recorded 1 hour after pain onset: There is at least 2 mm of inferior ST elevation, with reciprocal ST depression in aVL, ST flattening in V4-V6, and T-wave inversion in V2. Vital signs were normal.

Chest Pain 52

Chest Pain Aneurysm STEMI Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.

Coronary Angiogram 110

Coronary Angiogram Plaque Thrombosis STEMI 110

Dr. Smith's ECG Blog

JANUARY 5, 2024

The patient said his chest pain was 4/10, down from 8/10 on presentation. Although it is statistically unlikely, multiple plaque ruptures are possible. The PDA plaque was also bulky, but was not described as inflamed or ulcerated. The PDA plaque was also bulky, but was not described as inflamed or ulcerated.

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Angina Plaque Document Stents 121

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. There are multiple possible clinical situations that could account for diffuse subendocardial ischemia that is not due to ACS and plaque rupture. The syncope lasted about 2-3 minutes according to his wife.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 129

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

Here is the clinical story: A 40 year old male with no cardiac history presented with acute substernal chest pain that started 40 minutes prior to arrival. In spite of a relatively short QTc of 376 ms, the very low R-wave amplitude in V4 and the ST Elevation at 60 ms after the J-point in lead V3 contribute to a high final value.

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STEMI Stenosis Plaque Chest Pain 131

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.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain. A mid 60s woman with history of hypertension, hyperlipidemia, and GERD called 911 for chest pain. It is also NOT the clinical scenario of takotsubo (a week of intermittent chest pain).

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again. An angiogram is a " lumenogram " and does not "see" the extraluminal plaque.

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Plaque Stents Stent Chest Pain 67

BoardVitals - Cardiovascular

FEBRUARY 10, 2020

Cardiology Board Review Question A 48-year-old female with no known medical history presents with acute substernal chest pain. Patients typically present with acute chest pain, shortness of breath, or syncope. The most common presenting symptom is acute substernal chest pain. What are the Symptoms?

Cardiomyopathy 52

Cardiomyopathy Chest Pain Heart attacks Heart Attack 52

Dr. Smith's ECG Blog

JULY 11, 2024

Because: 1) He has been reading this blog for a long time. Case A 43 year old male with a history of DM II, hyperlipidemia, and a family history of myocardial infarction presented to a family clinic with two days of epigastric pain that started after consuming a meal. A chest x-ray in the ED found bilateral pleural effusions.

Outcomes 113

Outcomes Stenosis Outpatient Echocardiogram 113

MIBHS

DECEMBER 27, 2024

In this blog, well explore why anemia can occur after heart bypass surgery, how common it is, and how it can be managed. This condition occurs when the blood vessels that supply blood to the heart become blocked or narrowed by plaque buildup. It can also be considered a postoperative complications may hinder recovery.

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Coronary Artery Bypass Graft Open-Heart Surgery Kidney Disease Chronic Disease 52

Dr. Smith's ECG Blog

MARCH 9, 2017

Case A 42-year-old lady presented to the ED with complaints of intermittent episodes of chest pain associated with shortness of breath for the last 2 days. This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. This case was written by Sam Ghali: ( @EM_RESUS ). Normal ECG.”

Chest Pain 52

Chest Pain Angina Ischemia Plaque 52

MIBHS

OCTOBER 15, 2024

In this blog, we’ll break down the steps of coronary circulation, helping you understand how your heart maintains its own health while keeping the rest of the body alive and well. Angina : This is chest pain caused by reduced blood flow to the heart muscle, often triggered by physical exertion or stress.

Circulation 52

Circulation Heart attacks Heart Attack Chest Pain 52

Dr. Smith's ECG Blog

MAY 10, 2023

A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.

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Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Sanjay Gupta

DECEMBER 19, 2022

She asked me why I felt she had had a heart attack and I explained to her that she had had chest pains and the blood test indicating damage to the heart was elevated and that was all we needed to say that she had had a heart attack. On the basis of these findings we told her that she had suffered a heart attack.

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Heart attacks Heart Attack Blood Clot Chest Pain 40

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

Dr. Smith's ECG Blog

FEBRUARY 20, 2009

Here is a case of an 89 year old woman who had syncope but no chest pain or shortness of breath. There was a ruptured plaque with thrombus in the LAD, with some flow still (accounting for the inverted T waves). Her initial EKG (#1) shows some ST depression in V4-V6, possibly ischemic or possibly due to LVH.

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Chest Pain STEMI Ischemia Plaque 52

Dr. Smith's ECG Blog

JULY 11, 2018

A 40-something woman had sudden chest pain. Today, they viewed the angiogram and concluded that the thrombus at the mid RCA must have extended proximally from the culprit ruptured plaque, extending proximal to the RV marginal branch and temporarily occluding it. She called 911. But which myocardial walls are affected?

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Chest Pain STEMI Ischemia Blog 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2011

He did not state he had chest pain, but, then again, he couldn't remember anything. The ECG and ultrasound could not have been differentiated from acute plaque rupture with occlusion of the RCA. This 80 year old with a history of CABG had a cardiac arrest. There is concordant ST elevation in all inferior leads.

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Cardiac Arrest STEMI Ultrasound Chest Pain 52

AMS Cardiology

AUGUST 15, 2023

High cholesterol levels – Elevated levels of bad cholesterol can contribute to plaque buildup in your arteries, increasing the risk of heart disease. Routine blood pressure checks are essential to maintaining a healthy heart as high blood pressure often has no symptoms.

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Heart Disease Blood Pressure Risk Factors Cholesterol 52

Dr. Smith's ECG Blog

MARCH 27, 2018

The chief complaint was "chest pain." Male patient: I went back to the room of the first patient and he stated that he had been having chest pain on and off for 3 days. It was actually a dissection, not an atherosclerotic plaque rupture. Two Cases Male Patient I was handed this ECG of a 40-something male patient.

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Chest Pain Myocardial Infarction Plaque STEMI 52

Dr. Smith's ECG Blog

DECEMBER 23, 2022

Acute MI due to plaque rupture does happen in young people, including young women. Instead, in a patient with new chest pain and hyperacute inferior lead T waves — this picture that we see in lead V3 suggests associated posterior OMI until proven otherwise. Beware a low HEART score.

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Chest Pain Critical Care STEMI Plaque 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. His response: “subendocardial ischemia. A normal PR interval.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JULY 31, 2018

While ST coving in V1 is not necessarily abnormal — the presence of ST elevation in association with ST-T wave abnormalities in V2,V3 in a patient with chest pain is clearly cause for concern. Given that chest pain is resolving at the time ECG #2 was recorded — this supports the concept of dynamic ST-T wave changes in this patient.

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SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. As there was ruptured plaque, this is NOT Prinzmetal's angina. It is just as dangerous, as there is a ruptured plaque with thrombus (which lysed) in the proximal LAD. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, There was good flow. It was stented.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

JANUARY 4, 2021

FYI : 52 ng/L is the threshold for "rule in" by European studies as it has a high positive predictive value in the setting of chest pain. Case continued The patient was placed on a nitroglycerin drip and chest pain gradually resolved. Top right is colored iodine overlay; Blue areas of myocardium are ischemia.

Ischemia 40

Ischemia Pulmonary STEMI Chest Pain 40

Dr. Smith's ECG Blog

OCTOBER 23, 2022

She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. Serial ECGs correlated to the presence ( and severity ) of chest pain — often reveal the status of the "culprit" artery (ie, occluded, reopened, reoccluded ).

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STEMI Chest Pain Hospital Risk Factors 40