Frontiers in Cardiovascular Medicine

DECEMBER 13, 2023

Introduction Sudden cardiac arrest is a major cause of morbidity and mortality worldwide and remains a major public health problem for which better non-invasive prediction tools are needed. The individual relationship between fatal arrhythmias and cardiac function abnormalities in predicting cardiac death risk has rarely been explored.

Chest Pain 64

Chest Pain Cardiac Arrest Public Health Defibrillator 64

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

A woman in her 50s with dyspnea and bradycardia A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). HyperKalemia with Cardiac Arrest. Steve, what do you think of this ECG in this Cardiac Arrest Patient?" Is this just right bundle branch block? What is it?

Cardiac Arrest 141

Cardiac Arrest Bradycardia Tachycardia Chest Pain 141

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

A male in late middle age with a history of RCA stent 8 years prior complained of chest pain. Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. EMS recorded the following ECG: What do you see?

Chest Pain 52

Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Case submitted by Rachel Plate MD, written by Pendell Meyers A man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. His initial troponin T was 15 ng/L (only two hours since pain onset). He stated it was similar to prior heart attacks.

Chest Pain 52

Chest Pain Cardiac Arrest Cardiogenic Shock Heart attacks 52

Frontiers in Cardiovascular Medicine

OCTOBER 8, 2024

ObjectiveAlthough the association between admission glucose (AG) and major adverse cardiac events (MACE) is well-documented, its relationship with 30-day MACE in patients presenting with cardiac chest pain remains unclarified.

Chest Pain 52

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

There is no way to tell the difference between GI etiology of chest pain and MI. Such T-waves are almost always reciprocal to ischemia in the region of aVL (although aVL looks n ormal here) , and in a patient with chest pain are nearly diagnostic of ischemia. Could this have been avoided? Lesson : 1.

Cardiac Arrest 52

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med [Internet] 2019;Available from: [link] Should all patients with shockable arrest be taken to angiography regardless of STEMI or No STEMI?

Defibrillator 114

Defibrillator Cardiac Arrest STEMI Chest Pain 114

Dr. Smith's ECG Blog

JANUARY 25, 2017

A 20-something male drank heavily of ethanol and used cocaine, then was involved in a stressful verbal altercation, at which time he developed chest pain. See this post and associated case reports: Cardiac arrest, severe acidosis, and a bizarre ECG The patient was admitted and ruled out for acute MI by serial troponins.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Ischemia 52

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.

Chest Pain 52

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.

Chest Pain 123

Chest Pain Blog Cardiac Arrest Cardiomyopathy 123

Dr. Smith's ECG Blog

MAY 13, 2017

He complained of severe chest pain and was extremely agitated, so much so that he was throwing chairs in triage. Some time later, reperfusion T-waves developed (analogous to Wellens' waves): Case 3 Here is a case of a 30-something otherwise healthy male with chest pain: There is neither an S-wave nor J-wave in lead V3.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 6, 2019

The patient presented with chest pain. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. Is it Brugada pattern?

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

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.

Cardiac Arrest 52

Cardiac Arrest STEMI Ultrasound Chest Pain 52

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. He had multiple cardiac arrests with ROSC regained each time. Submitted by a Med Student, with Great Commentary on Bias!

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 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

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.

Tachycardia 128

Tachycardia Cardiac Arrest Ablation Research 128

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 (..)

STEMI 44

STEMI Chest Pain Cardiac Arrest Tachycardia 44

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.

Cardiac Arrest 98

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.

Chest Pain 98

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?

Cardiac Arrest 52

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.

Chest Pain 40

Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

JULY 24, 2018

One hour later (labs not yet returned), here is the ECG recorded just after the team noticed a sudden wide complex with precipitous decompensation, just before cardiac arrest: Bizarre, Brady, and Broad (wide QRS). Given the absence of chest pain — cardiac contusion is also unlikely.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Tachycardia ICU 52

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 ).

Blog 163

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.

Cardiac Arrest 52

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.

Cardiac Arrest 40

Cardiac Arrest Chest Pain Coronary Artery Disease Defibrillator 40

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?

Chest Pain 124

Chest Pain Ischemia Cardiac Arrest Blog 124

MIBHS

OCTOBER 31, 2024

Cardiac Arrest or Sudden Death: Cardiomegaly increases the risk of life-threatening arrhythmias, which can cause sudden cardiac arrest. Blood Clots: An enlarged heart is more prone to developing blood clots, which can lead to stroke or pulmonary embolism.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

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 ?

Blog 155

Blog STEMI Cardiac Arrest Tachycardia 155

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

He was at the gym when he had the onset of chest pain. Were it not for this prehospital ECG and the cardiac arrest, the diagnosis may have been significantly delayed. Had this happened, the artery may have re-occluded prior to angiography, with resultant recurrent cardiac arrest and/or shock and death.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Defibrillator STEMI 52

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 129

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 129

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.

Blog 98

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%.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

MAY 3, 2024

Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Here are some cases of RBBB with LAFB: What is the Diagnosis in this 70-something with Chest Pain?

Cardiogenic Shock 127

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

Dr. Smith's ECG Blog

OCTOBER 9, 2018

We record ECGs in triage on every patient with chest pain, and some other indications, and this amounts to 8000 ECGs in triage each year, costing at most $200,000 (8000 x $20.00). Given the dire consequences of missing a STEMI or OMI, including cardiac arrest (see cases below), $5700 is extremely cheap.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Blog 52

Dr. Smith's ECG Blog

JULY 22, 2023

Written by Pendell Meyers A man in his 70s with no cardiac history presented with acute weakness, syncope, and fever. He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher.

Chest Pain 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

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.

Chest Pain 52

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.

Blood Pressure 52

Blood Pressure Heart attacks Heart Attack Heart Rhythm 52