Cardiogenic Shock, Chest Pain and Outcomes

Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin.

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. Long term outcome is unavailable. His history included known heart failure with prior EF 18%, insulin dependent diabetes, and polysubstance abuse.

Chest Pain

Chest Pain STEMI Cardiogenic Shock Heart Failure

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. The average age of the patients was 65.23 ± 12.66 years, The median AG levels were 7.60 mmol/L

Chest Pain

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction

3 days of shoulder and chest pain, and now cardiogenic shock

Dr. Smith's ECG Blog

AUGUST 28, 2020

Bad chest pressure with severe left shoulder pain 3 nights ago. Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." Cardiogenic shock and ACS is an indication for the cath lab, even if you don't think there is OMI.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ischemia Stenosis

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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. His prehospital ECG was diagnostic of inferior posterior OMI. BP was 108 systolic (if a cuff pressure can be trusted) but appeared to be maintaining BP only by very high systemic vascular resistance.

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

OCTOBER 24, 2019

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." Lobo et al. examined SCAD presenting as STEMI (unlike Hassan et al.

Chest Pain

Chest Pain SCAD STEMI Cardiogenic Shock

A man in his 70s with chest pain

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. He was in cardiogenic shock requiring an impella for several days after cath.

Chest Pain

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack

Case Report: Massive intrapericardial hematoma following acupuncture therapy

Frontiers in Cardiovascular Medicine

OCTOBER 14, 2024

This paper reports a case of an elderly female patient who experienced severe chest pain and syncope during acupuncture therapy, subsequently diagnosed with traumatic hemopericardium and acute cardiac tamponade, complicated by cardiogenic shock.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ultrasound Hemorrhage

A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Queen of Hearts Interpretation: Would 20 minutes earlier diagnosis have made a difference in his clinical outcome?

Chest Pain

Chest Pain Myocardial Infarction STEMI Pacemaker

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

This year’s theme, “Advancing Cardiovascular Care for All” brings the latest practice-changing breakthroughs, along with top experts debating and discussing outcomes of highly-anticipated clinical trials. 24 from April 6 - 8, 2024 in Atlanta, GA at the Georgia World Congress Center.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

Chest discomfort and a dilated right ventricle. What's going on?

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

Just the fact of chest pain and highly elevated troponin is enough to activate the cath lab, but here you can see just how subtle hyperacute T-waves can be. 2) Typical persistent chest pain with a sigificantly elevated troponin is OMI until proven otherwise, regardless of the ECG.

Pulmonary

Pulmonary Tricuspid Chest Pain Cardiogenic Shock

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. YOU TOO CAN HAVE THE PM Cardio AI BOT!!

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

The ECG told the whole story, but no one listened: ECG interpretation skills are critical to patient outcomes.

Dr. Smith's ECG Blog

MARCH 30, 2014

Then the notes mention "cardiogenic shock" but without any reference to a cardiac echo or to a chest x-ray. Now chest pain free. Cardiologist note says: "Elevated troponin explained by type II MI due to her shock." After midnight (now day 3), she complains of shoulder pain and dyspnea.

Outcomes

Outcomes Cardiogenic Shock STEMI Chest Pain

What is the infarct artery? What does the post PCI ECG show? What does the convalescent ECG show?

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. His included cardiogenic shock, V Tach, AV block.

Aneurysm

Aneurysm Chest Pain Cardiogenic Shock Blog

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He was asked multiple times about chest pain or dyspnea, but repeatedly denied any such symptoms. Patient denied chest pain on initial review of symptoms. Was now endorsing chest pain which began 30 minutes ago. Upon further questioning, he states that he has had intermittent chest pain since yesterday.

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Dr. Smith's ECG Blog

JULY 18, 2014

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. such Q-waves are associated with larger MI and worse outcomes (2. There was some SOB. He had walked into the ED (did not use EMS). Obviously there is MI.

STEMI

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock

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. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1.

Ischemia

Ischemia STEMI Stenosis Chest Pain

How does Acute Total Left Main Coronary occlusion present on the ECG?

Dr. Smith's ECG Blog

AUGUST 9, 2019

His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. This is her ECG: An obvious STEMI, but which artery?

Myocardial Infarction

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

The First 60 Minutes of a Heart Attack: The Golden Hour

Wellnest

JULY 19, 2023

When a person experiences a heart attack or myocardial infarction, they may feel chest pain and other symptoms in different parts of their body. It is imperative to act swiftly when faced with such a medical emergency to ensure the best possible outcome. So, how do you recognize a heart attack?

Heart Attack

Heart Attack Heart attacks Blood Pressure Myocardial Infarction

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. She awoke in the morning with sharp chest pain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.

Tachycardia

Tachycardia Pulmonary Chest Pain Stenosis

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

Chest Pain

Chest Pain Ischemia Plaque Stents

Cardiovascular Update

Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin.

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

3 days of shoulder and chest pain, and now cardiogenic shock

Webinars

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

A young peripartum woman with Chest Pain

A man in his 70s with chest pain

Case Report: Massive intrapericardial hematoma following acupuncture therapy

A man in his 70s with acute chest pain and paced rhythm.

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

Chest discomfort and a dilated right ventricle. What's going on?

Should we activate the cath lab? A Quiz on 5 Cases.

The ECG told the whole story, but no one listened: ECG interpretation skills are critical to patient outcomes.

What is the infarct artery? What does the post PCI ECG show? What does the convalescent ECG show?

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

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

How does Acute Total Left Main Coronary occlusion present on the ECG?

The First 60 Minutes of a Heart Attack: The Golden Hour

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

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