Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI? What was the pH and K?

Ischemia 112

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 112

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. A recent similar case: A 40-something with chest pain. Is this inferior MI?

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

APRIL 15, 2019

If a patient presents with chest pain and a normal heart rate, or with shockable cardiac arrest, then ischemic appearing ST elevation is STEMI until proven otherwise. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

Tachycardia 52

Tachycardia STEMI Chest Pain Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

He did not have chest pain. Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. Chest pain in high risk patient. Here is his triage ECG: What do you think? What does the ECG show? Also see the bizarre Bigeminy. Is it STEMI?

Ischemia 115

Ischemia Chest Pain Cardiac Arrest Blog 115

Dr. Smith's ECG Blog

MAY 5, 2022

He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. They recommended repeating his ECG and awaiting troponin since the patient did not have any chest pain. Steve, what do you think of this ECG in this Cardiac Arrest Patient?" What is it?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Although in the context of chest pain such ST depression would be all but diagnostic of posterior OMI, one should make no conclusions in such an unusual case. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. In all leads, there is a 2nd wave after the initial QRS.

Cardiac Arrest 52

Cardiac Arrest Bradycardia Chest Pain Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain. Here is his first ED ECG: What do you see?

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — Unfortunately, before this could be accomplished — the patient went into cardiac arrest. She was successfully resuscitated — with a post-arrest rhythm similar to that seen in Figure-1. Cardiac cath did not reveal significant coronary disease!

Blog 104

Blog Pacemaker Bradycardia Arrhythmia 104

Dr. Smith's ECG Blog

MAY 26, 2023

And she does not know that this is an overdose; she thinks it is a patient with chest pain!! This meets the Smith Modified Sgarbossa criteria, but the situation is wrong for diagnosing OMI!! By the way, the PM Cardio Bot Queen of Hearts says this is Not OMI with High Confidence. 3 hours later, this was recorded at a K of 2.8

Cardiogenic Shock 86

Cardiogenic Shock Arrhythmia Blog Education 86

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If Is this Type 2 Brugada syndrome/ECG pattern?

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. The elevated troponin was attributed to either type 2 MI or to non-MI acute myocardial injury. There is no further workup at this time. Smith: Here is a case that was just texted to me today from a former resident. This patient ruled out for MI.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma?

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52