Dr. Smith's ECG Blog

JANUARY 8, 2024

Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization): The patient is 40 years old and presented to another hospital with chest pain and SOB. She had been sitting doing work when she experienced "waves of chest tightness". Sats were 88%.

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Chest Pain Pulmonary Embolism STEMI 71

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 Stent 108

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.

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Dr. Smith's ECG Blog

JULY 25, 2024

But cardiac arrest is a period of near zero flow in the coronary arteries and causes SEVERE ischemia. After cardiac arrest, I ALWAYS wait 15 minutes after an ECG like this and record another. Just as important is pretest probability: did the patient report chest pain prior to collapse?

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Cardiac Arrest Ischemia Tachycardia Defibrillator 110

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 Electrophysiology 40

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!

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Cardiac Arrest Chest Pain Embolism Pulmonary 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 52

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?

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Cardiac Arrest Bradycardia Tachycardia Chest Pain 136

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 Stent 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?

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Defibrillator Cardiac Arrest STEMI Chest Pain 91

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.

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Chest Pain STEMI Cardiac Arrest Ischemia 52

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?

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Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty 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?

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Chest Pain STEMI Ischemia Myocardial Infarction 52

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

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 107

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.

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Chest Pain STEMI 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.

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Cardiac Arrest Myocardial Infarction Chest Pain Ischemia 52

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 89

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 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 86

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.

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Cardiac Arrest Tachycardia Chest Pain ICU 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.

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Tachycardia Cardiac Arrest Ablation Research 128

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.

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Chest Pain Cardiac Arrest Ischemia STEMI 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

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 164

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

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?

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Ischemia Chest Pain Cardiac Arrest Blog 112

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

Wellnest

DECEMBER 21, 2022

If you experience any symptoms, such as chest pain, dizziness, unusual tiredness or fatigue, shortness of breath, or irregular heartbeat, your doctor would want you to go for an ECG test to find out the underlying cause. Cardiac arrest Cardiac arrest is a medical emergency in which the heart stops pumping blood to the body.

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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?

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 125

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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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 162

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.

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Chest Pain STEMI Cardiac Arrest Blog 52

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.

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Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Wellnest

MARCH 12, 2023

It occurs when blood flow to the coronary arteries is restricted, frequently by a blood clot, which can harm the heart muscle and result in consequences like heart disease or sudden cardiac arrest. By being aware of the early warning symptoms, you can see potential cardiac issues before they worsen.

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Heart Disease Heart Attack Heart attacks Blood Pressure 52

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

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.

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