Bradycardia Chest Pain Heart Disease 
Dr. Smith's ECG Blog
JANUARY 23, 2023
Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin.
Dr. Smith's ECG Blog
JULY 5, 2023
The patient has acute chest pain. Instead — my thoughts were as follows: The rhythm is sinus , with marked bradycardia and a component of sinus arrhythmia. This was texted to me in real time. What do you think? Here was my answer: "Not ischemia. Maybe HOCM or another form of LVH. I would not activate cath lab.
Dr. Smith's ECG Blog
MARCH 15, 2023
This middle-aged patient has a remote history of cardiac surgery as a young child for a "heart murmur". She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. Exam was completely normal except for an irregular heart rate. She was on no medications.
Dr. Smith's ECG Blog
AUGUST 9, 2024
Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. Do not treat AIVR. Is there STEMI?
Dr. Smith's ECG Blog
JANUARY 23, 2024
There was no chest pain. She had no known heart condition. Even though the primary suspicion was not ischemic heart disease, a CT angiogram was performed, and it revealed normal coronary arteries. This ruled out coronary disease as the cause of conduction system disease.
EMS 12-Lead
JUNE 1, 2022
Smith and Myers found that in otherwise classic Wellens syndrome – that is, prior anginal chest pain that resolves with subsequent dynamic T wave inversions on the ECG – even the T waves of LBBB behave similarly. [2] LBBB is typically the result of preexisting hypertrophy, ischemic heart disease, or cardiomyopathy.
Ken Grauer, MD
OCTOBER 4, 2024
To improve visualization — I've digitized the original ECG using PMcardio ) MY Thoughts on the ECG in Figure-1: This is a challenging tracing to interpret — because there is marked bradycardia with an irregular rhythm and a change in QRS morphology. Did the patient have some form of underlying heart disease?
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