Cardiac Arrest, Chest Pain and Myocardial Infarction

Missed myocardial infarction with subsequent cardiac arrest

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

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia

75 year old dialysis patient with nausea, vomiting and lightheadedness

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. Clinical characteristics of dialysis patients with acute myocardial infarction in the United States.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

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

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter

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Bridging Innovation & Patient Care: The Growing Role of AI

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Abstract 4135360: Eosinophilic Myocarditis: An Atypical Presentation with a Labile Course: A Case Report

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. TTE showed a reduced EF with multiple segmental abnormalities concerning for myocardial infarction. Electrocardiogram (EKG) was unremarkable.

Myocardial Infarction

Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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).

Plaque

Plaque Chest Pain Thrombosis Stenosis

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

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.

Ischemia

Ischemia STEMI Stenosis Chest Pain

ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

Dr. Smith's ECG Blog

JANUARY 4, 2021

Both of these patterns together suggest Aslanger's pattern , recently published in J Electrocardiology: A new electrocardiographic pattern indicating inferior myocardial infarction. 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.

Ischemia

Ischemia Pulmonary STEMI Chest Pain

Understanding the Difference Between Heart Attack and Cardiac Arrest

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?

Cardiac Arrest

Cardiac Arrest Heart Attack Heart attacks Chest Pain

An intoxicated, agitated, 29 year old with chest pain

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. Differences in electrocardiographic Findings Between Acute Isolated Right Ventricular Myocardial Infarction and Acute Anterior Myocardial Infarction. His chest pain resolved.

Chest Pain

Chest Pain STEMI Cardiac Arrest Myocardial Infarction

Impact of admission glucose and 30-day major adverse cardiovascular events on patients with chest pain in an emergency setting: insights from the China EMPACT registry

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

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction

Chest Pain and Right Bundle Branch Block

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

Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

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 Most recent echo showed EF of 60%. He also had a history of chronic kidney disease, stage III.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

A Middle-Aged male with Chest Pain and an Unusual ECG

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.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

No chest pain. His inpatient clinicians did not think that an urgent angiogram was warranted given that he was chest pain free, his EKG appeared nondiagnostic, and serial troponins were not elevating beyond 2 ug/L. Patients on dialysis often do not have chest pain in the setting of acute MI. Why is this?

Chest Pain

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia

Another Inadequate Paper Published on Triage ECGs, whose Conclusions Need Scrutiny.

Dr. Smith's ECG Blog

OCTOBER 9, 2018

The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardial infarction. 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). Am J Emerg Med 36(10):1771-1774.

Chest Pain

Chest Pain STEMI Cardiac Arrest Blog

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

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.

Chest Pain

Chest Pain Cardiogenic Shock Tachycardia Ischemia

What are treatment options for this rhythm, when all else fails?

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. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

This ECG was texted to me after the fact with no information. What do you think?

Dr. Smith's ECG Blog

OCTOBER 13, 2023

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. Patient states that he began to develop substernal chest pain two days ago. ng/ml) The sender asked: "Would you activate the cath lab?"

Chest Pain

Chest Pain STEMI Cardiac Arrest Myocardial Infarction

Chest pain and hypotension in a patient who is 3 weeks post STEMI

Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. In the ED he had some continued chest pain and hypotension. In a report of 6 cases at our institution (Hennepin County Medical Center), 2 survived with cardiac surgery.

Chest Pain

Chest Pain STEMI Pericarditis Ultrasound

ECPR for cardiac arrest caused by abnormal uterine bleeding and coronary vasospasm: a case report

Frontiers in Cardiovascular Medicine

DECEMBER 20, 2024

IntroductionCardiac arrest during pregnancy is receiving increasing attention. However, there are few reports on cardiac arrest in nonpregnant women caused by abnormal uterine bleeding (AUB). At the initial stage of admission, cardiac arrest occurred after the ECG demonstrated ST-segment elevation in leads II, III and a VF.

Cardiac Arrest

Cardiac Arrest Chest Pain Coronary Angiogram Myocardial Infarction

When ACS care is very delayed, "STEMI metrics" can be perfect. And how specific is Queen of Hearts?

Dr. Smith's ECG Blog

MARCH 23, 2025

Written by Pendell Meyers, sent by anonymous, with additions by Smith A man in his 40s had acute chest pain and called EMS. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future? JAMA [Internet] 2005;293(8):97986.

STEMI

STEMI Chest Pain Myocardial Infarction Article

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

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 her prehospital ECG: What do you think? DOI: 10.1016/j.resuscitation.2025.110515

Defibrillator

Defibrillator Cardiac Arrest Myocardial Infarction STEMI

Cardiovascular Update

Missed myocardial infarction with subsequent cardiac arrest

75 year old dialysis patient with nausea, vomiting and lightheadedness

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Webinars

Abstract 4135360: Eosinophilic Myocarditis: An Atypical Presentation with a Labile Course: A Case Report

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

Understanding the Difference Between Heart Attack and Cardiac Arrest

An intoxicated, agitated, 29 year old with chest pain

Impact of admission glucose and 30-day major adverse cardiovascular events on patients with chest pain in an emergency setting: insights from the China EMPACT registry

Chest Pain and Right Bundle Branch Block

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

A Middle-Aged male with Chest Pain and an Unusual ECG

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Another Inadequate Paper Published on Triage ECGs, whose Conclusions Need Scrutiny.

An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

What are treatment options for this rhythm, when all else fails?

This ECG was texted to me after the fact with no information. What do you think?

Chest pain and hypotension in a patient who is 3 weeks post STEMI

ECPR for cardiac arrest caused by abnormal uterine bleeding and coronary vasospasm: a case report

When ACS care is very delayed, "STEMI metrics" can be perfect. And how specific is Queen of Hearts?

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

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