Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. A repeat ECG was recorded with pain 2/10: Not much change.

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Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

JUNE 5, 2024

The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder.

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Chest Pain Blog Cardiac Arrest Cardiomyopathy 121

Dr. Smith's ECG Blog

SEPTEMBER 20, 2011

This 80 year old with a history of CABG had a cardiac arrest. He did not state he had chest pain, but, then again, he couldn't remember anything. He was resuscitated after fairly prolonged down time, but regained consciousness, though he was confused. There is concordant ST elevation in all inferior leads.

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Cardiac Arrest STEMI Ultrasound Chest Pain 52

Dr. Smith's ECG Blog

DECEMBER 23, 2014

The patient was diagnosed with esophageal reflux and was being discharged by the nurse when he had a cardiac arrest. Formula : There is not enough ST elevation in V2-V4 to be applying the LAD/early repol formula, but if it is applied, one gets 1.5 The formula results in 23.43, just above the 23.4 He was defibrillated.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia STEMI 52

American College of Cardiology

NOVEMBER 5, 2024

A small proportion of patients with STEMI treated via primary PCI experienced late ventricular tachycardia (VT) or ventricular fibrillation (VF), occurring one or more days following the procedure, but late VT or VF with cardiac arrest occurred rarely, especially among patients with uncomplicated STEMI, according to a study published in JAMA Network (..)

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STEMI Chest Pain Cardiac Arrest Tachycardia 46

DAIC

JUNE 19, 2024

Patients may feel a fluttering in the chest, chest pain, shortness of breath and dizziness or lightheadedness as a result. If VT is not treated, it can lead to cardiac arrest, which is when the heart stops beating. In fact, VT is the most common cause of sudden cardiac arrest.

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Tachycardia Cardiac Arrest Ablation Research 128

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation.

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Dr. Smith's ECG Blog

AUGUST 19, 2023

Because the patient had no chest pain or shortness of breath, they were initially diagnosed as gastroenteritis. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. Potassium was normal. Cardiology did not think it was "STEMI", but repeated the troponin. Take home 1.

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Chest Pain STEMI Myocardial Infarction Blog 98

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?

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Cardiac Arrest Defibrillator Ischemia Tachycardia 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 40

Ken Grauer, MD

FEBRUARY 3, 2024

Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Figure-1: The initial ECG in today's case — obtained after successful resuscitation from cardiac arrest. ( No CP ( C hest P ain ).

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Blog Cardiac Arrest STEMI Plaque 163

Dr. Smith's ECG Blog

JULY 14, 2010

A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. Before EMS arrived, she had "seizure activity" and became unresponsive. She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. She was intubated.

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Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator 52

Circulation: Arrhythmia and Electrophysiology

JANUARY 29, 2024

BACKGROUND:There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation. Circulation: Arrhythmia and Electrophysiology, Ahead of Print.

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Cardiac Arrest Chest Pain Coronary Artery Disease Defibrillator 40

Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. C ASE C onclusion: As noted above — the middle-aged man in today's case presented to the ED in cardiac arrest. In view of this history — How would YOU interpret the ECG in Figure-1 ?

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Blog STEMI Cardiac Arrest Tachycardia 161

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). Having looked for negative U waves in patients with chest pain over a period of decades — I'll emphasize that this is not a common finding.

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Blog Chest Pain Ischemia STEMI 98

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chest pain. Vitals were HR 58 BP 167/70 R20 sat 96%.

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Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

JUNE 15, 2013

There was no chest pain. Unfortunately, the patient had a cardiac arrest on arrival to the cath lab, before return of the potassium. A patient who does not present with chest pain should be particularly scrutinized for other causes of the ECG abnormalities. The computer read inferior MI.

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Chest Pain STEMI Cardiac Arrest 52

MIBHS

JULY 31, 2024

While many arrhythmias are harmless, some can be life-threatening and increase your risk of stroke, heart failure, and sudden cardiac arrest. This can lead to chest pain (angina) and increase your risk of heart attack or stroke, especially if you already have underlying heart disease.

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Blood Pressure Heart Attack Heart attacks Heart Rhythm 52

Dr. Smith's ECG Blog

DECEMBER 13, 2023

This middle aged patient presented with chest pain: What do you think? There is VERY low voltage. There is some ST Elevation, but it is MINIMAL. But look how small the QRS is!! Let's stretch out the QRS vertically so it is not so tiny: On upper left is the original.

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Blog Chest Pain Cardiac Arrest Hemorrhage 122

Circulation

NOVEMBER 11, 2024

Case presentation:A 64-year-old man presented with one day of chest pain. Initial evaluation showed elevated cardiac enzymes (CE) and normal eosinophil count. He had a cardiac arrest during the procedure and was placed back on ECMO. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024.

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Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain 40

Dr. Smith's ECG Blog

AUGUST 1, 2020

He has done a lot of great work on cardiac arrest, including as co-author of our study on esmolol in refractory cardiac arrest, and much more with Keith Lurie. A 40-something woman was in a remote alpine location when she complained of crushing chest pain. See his Google Scholar profile here.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Ischemia 52

Ken Grauer, MD

APRIL 9, 2023

No chest pain. Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. What is the rhythm ?

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Blog Chest Pain Arrhythmia Cardiac Arrest 78

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).

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Plaque Chest Pain Thrombosis Stenosis 52

MIBHS

MARCH 31, 2025

When discussing heart health, heart attacks and cardiac arrest are two terms that are often mistaken for one another. Understanding the difference between heart attack and cardiac arrest can help in recognizing symptoms, seeking prompt medical care, and even saving lives. What is Cardiac Arrest?

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Cardiac Arrest Heart Attack Heart attacks Chest Pain 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. Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Case A 47 year old male called 911 for severe chest pain. He had a previous MI with cardiac arrest 2 years prior. A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chest pain with radiation to the anterior neck, with associated nausea.

Ischemia 40

Ischemia Chest Pain STEMI Stenosis 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.

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Ischemia Pulmonary STEMI Chest Pain 40

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. It is important to remember that not every acute MI with ST elevation is the result of acute coronary occlusio n. Clinical Context is everything !

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Tachycardia STEMI Chest Pain Ischemia 40

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

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Cardiogenic Shock Arrhythmia Blog Education 98

Ken Grauer, MD

OCTOBER 27, 2023

Given the history of dyspnea on exertion over a several week period ( but no mention of chest pain ) — and — the finding of deep, symmetric T wave inversion in the anterior leads ( as per Pearl #2 ) — it is possible that the onset of her symptoms is the result of a "Silent MI" ( See ECG Blog #228 for more on "Silent" MI ). . =

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Blog Pacemaker Bradycardia Arrhythmia 101

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

This is often quite challenging to recognize — but the finding of negative U waves in a patient with chest pain is highly suggestive of ischemia ! Anterior leads, such as V2 and V3 — as well as lead II — often show U waves best, though they may appear in any lead. N OTE # 2 — On rare occasions, the U wave may be negative.

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Chest Pain Cardiac Arrest Bradycardia Ischemia 52

EMS 12-Lead

JULY 24, 2023

But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chest pain was a little more intense, and the needed recovery period was longer in duration. Then, she attempted to reengage the activities at hand, and initially tolerated this well.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 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?

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

LEARNING Point: Maximal ST depression in leads V2-thru-V4 ( especially when the ST-T waves are shaped as they are in ECG #1 ) in a patient with new chest pain ( or sudden cardiac arrest, as in today’s case ) — is diagnostic of acute Posterior OMI until proven otherwise!

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STEMI Hospital Blog Defibrillator 52

DAIC

MARCH 1, 2024

Photo by Cedars-Sinai milla1cf Fri, 03/01/2024 - 08:25 March 1, 2024 — Two new studies by Cedars-Sinai investigators support using artificial intelligence (AI) to predict sudden cardiac arrest-a health emergency that in 90% of cases leads to death within minutes.

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Cardiac Arrest Electrocardiogram Defibrillator Electrophysiology 111

Dr. Smith's ECG Blog

JUNE 23, 2024

However, he did not remember much from the day of the arrest. He did not remember whether he had experienced any chest pain. Within a few days, the patient was extubated and was neurologically intact. At his family's request, he was transferred to a hospital closer to his home to continue care. He was admitted to cardiology.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 117

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

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Ischemia Arrhythmia Defibrillator Chest Pain 40