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

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 Chest Pain 161

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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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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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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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.

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Ischemia Chest Pain STEMI Stenosis 40

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

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

My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. Unfortunately, before this could be accomplished — the patient went into cardiac arrest. Cardiac cath did not reveal significant coronary disease!

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Blog Pacemaker Bradycardia Arrhythmia 101

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. The formal diagnosis codes were populated to the chart by the primary hospitalization teams.

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Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

JUNE 23, 2024

He was intubated in the field and sedated upon arrival at the hospital. However, he did not remember much from the day of the arrest. He did not remember whether he had experienced any chest pain. At his family's request, he was transferred to a hospital closer to his home to continue care.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 117

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

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? She was discharged after a short hospitalization with oncology and cardiology follow-up. She was noted to be tachycardic and her heart sounds were distant on physical exam. This patient is only pseudo-stable.

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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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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. He was prescribed apixaban. What is the Diagnosis?

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Dr. Smith's ECG Blog

OCTOBER 25, 2023

He did not have chest pain. The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. Chest pain in high risk patient.

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Ischemia Chest Pain Cardiac Arrest Blog 123

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.

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Cardiac Arrest Chest Pain Tachycardia ICU 52

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.

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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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Dr. Smith's ECG Blog

MAY 3, 2024

In fact, most do not make it to the hospital alive, which explains why only a tiny percent of OMI are due to full LM occlusion. 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.

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Cardiogenic Shock Cardiac Arrest Hospital Ischemia 126

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. If cardiac arrest from hypokalemia is imminent (i.e., As I indicated above, in our cardiac arrest case, after pushing 40 mEq, the K only went up to 4.2 The mean serum potassium level was lower after resuscitation from cardiac arrest (3.6

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STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 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.

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Cardiac Arrest Heart attacks Heart Attack Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 9, 2018

C harges and cost have no relation to each other in hospital billing. No, again, charges and cost have no relation to each other in hospital billing. 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).

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Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Other cases of LAD OMI with RBBB/LAFB: A man in his 40s who really needs you to understand his ECG Cardiac Arrest at the airport, with an easy but important ECG for everyone to recognize A woman in her 60s with 6 hours of chest pain, dyspnea, tachycardia, and hypoxemia Ventricular Fibrillation, ROSC after perfusion restored by ECMO, then ECG.

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Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

Written by Pendell Meyers, edits by Steve Smith A man in his 60s with history of hypertension and MI 10 years ago, with PCI, presented to an outside hospital complaining of chest pain that started while mowing the lawn. Here is his ECG on arrival: What do you think?

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Chest Pain STEMI Cardiac Arrest Aneurysm 52

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.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 130

Ken Grauer, MD

JUNE 6, 2023

Unfortunately — the patient abruptly developed hypoxemia, followed by cardiac arrest with PEA. Apparently while waiting on the hospital floor for the decision regarding optimal aortic replacement — the patient took one of his sublingual NTG ( nitroglycerin ) tablets. He could not be resuscitated.

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Blog Pulmonary Hypertension Aortic 78

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. Steve, what do you think of this ECG in this Cardiac Arrest Patient?" What is it?

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Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain. Here is his first ED ECG: What do you see?

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Dr. Smith's ECG Blog

NOVEMBER 24, 2017

However, according to these diagnostic criteria (JACC 2011; 57(7):802), it is a Bazett corrected QT of less than 330-370, depending on other diagnostic criteria, including 1) h/o cardiac arrest, 2) sudden syncope, 3) family hx of sudden unexplained arrest at age less than 40, 4) family hx of SQTS. Some other points: 1.

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Bradycardia Article Atrial Fibrillation Chest Pain 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. Comment by K EN G RAUER, MD ( 2/11 /2023 ): = Today’s case is from a patient with “many complaints”, including chest pain — and, an ECG that raised concern about acute anterior OMI. The computer called this Acute STEMI What do you think? The ioninzed calcium was 6.5

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

OCTOBER 13, 2023

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 Here is the history: 62 yo male w 2d of intermittent chest pain, now constant. Here is a more detailed history: Presented to the emergency department with chest pain. My response was: "It depends on the patient.

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Chest Pain STEMI Cardiac Arrest Myocardial Infarction 115

Dr. Smith's ECG Blog

APRIL 9, 2025

A middle-age woman with no previous cardiac history called 911 for chest pain. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. This was before thrombolytics gained full use in our admitting hospital.

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Defibrillator Cardiac Arrest STEMI Myocardial Infarction 63

Dr. Smith's ECG Blog

APRIL 18, 2025

He played a round of golf a week prior and felt an episode of chest pain during the round, which spontaneously resolved. On presentation, he reported no chest pain or shortness of breath. The patient should have immediately been sent for further cardiac evaluation at a PCI center based on this EKG.

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Chest Pain Cardiac Arrest Tachycardia ICU 80

Dr. Smith's ECG Blog

APRIL 16, 2025

Sent by anonymous, written by Pendell Meyers A woman in her 40s with no known comorbidities presented with acute chest pain radiating to left arm and neck, which started approximately 4 hours prior to arrival. She survived the hospitalization, but long term outcome is not available. PMcardio digitized image.

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Chest Pain STEMI Tachycardia Cardiac Arrest 100