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. The patient was extubated on Day-3 of the hospital stay. The below ECG was recorded.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 1 remained in the hospital overnight.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stent 116

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. The history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

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?

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

This is the initial ED ECG of a 46 year old male with chest pain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 Case 4 Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 Case 1 Acute anterior STEMI from LAD occlusion, or Benign Early Repolarization (BER)?

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain. We have countless cases of missed posterior MI on this blog, including these: Interventionalist at the Receiving Hospital: "No STEMI, no cath. Canto et al. Is that normal?

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

Circulation

NOVEMBER 11, 2024

The relationship between low RHR and CI has yet to be described.Purpose:We hypothesize that resting sinus bradycardia (low RHR) could be a predictor of chronotropic incompetence and reduced exercise capacity.Methods:The derivation cohort consists of 201 patients with normal Bruce protocol treadmill stress echocardiogram. x age in years).Results:The

Exercise 40

Exercise Chest Pain Myocardial Infarction Bradycardia 40

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. He complained of generalized weakness and left lower extremity numbness. What is it? Activate the Cath Lab?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Wellnest

DECEMBER 21, 2022

Patients use them to observe their heart activity by themselves when they are not in the hospital. Though their accuracy is not as high as a hospital ECG machine, they are very beneficial in detecting problems in any medical emergency and providing information about long-term heart activity.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Ken Grauer, MD

OCTOBER 27, 2023

That said — obvious findings include: i ) Marked bradycardia! — My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. The rhythm in Figure-1 is complex — and defies precise interpretation without careful study. be regular! —

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Blog Pacemaker Bradycardia Arrhythmia 103

Dr. Smith's ECG Blog

NOVEMBER 24, 2017

The rule of thumb is less accurate, and the risk is higher because a long QT in the presence of bradycardia ("pause dependent" Torsades) predisposes to Torsades. 6) Use a different rule of thumb for bradycardia : Manually approximate both the QT and the RR interval. 3) At heart rates below 60, far more caution is due.

Bradycardia 52

Bradycardia Article Atrial Fibrillation Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 15, 2023

Even if you don't see the OMI, you can usually prevent such a long delay to reperfusion by recording serial ECGs every 15 minutes for a patient with persistent chest pain. The rhythm in ECG #1 is sinus bradycardia and arrhythmia. Record serial ECGs every 15 minutes!! Hillinger et al.

Chest Pain 52

Chest Pain Blog Bradycardia Stent 52

EMS 12-Lead

JUNE 1, 2022

Hospital transport was unremarkable. 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] He received a permanent pacemaker during the subsequent inpatient stay.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

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 98

Cardiogenic Shock Arrhythmia Blog Education 98

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

After the heart rate increased slightly, here was the repeat ECG: Sinus bradycardia, only slightly faster rate than prior. See these similar cases: A man in his sixties with chest pain Why is there inferior ST elevation, and would you get posterior leads? Sudden CP and SOB with Inferior ST Elevation and in STE in V1.

Blog 52

Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. mg/dL [1.03 0.16

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

JULY 24, 2018

Written by Pendell Meyers We received a call from an outside hospital asking to transfer a "traumatic post arrest" patient. We were told that a young patient was brought in with altered mental status but complaining of right hip and/or leg pain after being found by his mother at the bottom of the stairs into the basement.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Tachycardia ICU 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. There’s sinus bradycardia, normal conduction, normal axis, delayed R wave progression, and normal voltages. Sinus bradycardia.” paramedic transportation to the ED as “chest pain, STEMI negative” 2.

Chest Pain 86

Chest Pain STEMI Bradycardia Myocardial Infarction 86

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Frequent or repetitive PACs ii.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Written by Kirsten Morrissey, MD with edits by Bracey, Grauer, Meyers, and Smith An older teen was transferred from an outside hospital with elevated serum troponin and and ECG demonstrating ST elevations. The workup at the transferring hospital yielded elevated troponin I at 18.1 He reported 1.5 mg/L and a normal WBC of 8.8.

Pediatrics 121

Pediatrics Pericarditis COVID-19 Congenital Heart Disease 121

Dr. Smith's ECG Blog

MARCH 19, 2025

Despite the baseline artifact theres sinus bradycardia, convex ST elevation in III, reciprocal ST depression in aVL and possible anterior ST depression indicating inferoposterior OMI. He was given two separate sprays of nitroglycerin sublingually, neither of which improved his pain but did cause him to become briefly hypotensive ( 600 ng/L.

Chest Pain 116

Chest Pain STEMI Stent Stents 116

Ken Grauer, MD

JANUARY 2, 2025

The patient tolerated cardioversion well and later that day was discharged from the hospital. ( PEARL # 2: Did you notice in the post-conversion tracing that there is ST segment coving with fairly deep T wave inversion in the chest leads? Serum electrolytes were normal at the time of cardioversion.

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Blog Chest Pain Bradycardia Tachycardia 169

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. En route to the next hospital, the paramedics recorded another 12-lead tracing. Also : See Ken Grauer's excellent comments at the bottom.

Chest Pain 68

Chest Pain Stent Stents Risk Factors 68