Post-stent chest pain, revisited
Heart Sisters
JULY 28, 2024
Heart patients with persistent or recurrent post-stent chest pain present “an unmet clinical need”, according to the European Journal of Cardiology.
Chest Pain Related Topics 
ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain
ECG Cases
APRIL 2, 2024
In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.
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Which patient has the more severe chest pain?
Dr. Smith's ECG Blog
SEPTEMBER 26, 2023
2 middle aged males presented with chest pain. Which had the more severe chest pain at the time of the ECG? Patient 2 at the bottom with a very subtle OMI complained of 10/10 chest pain at the time the ECG was recorded. 414 patients were included in the analysis.
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A 50-something with chest pain.
Dr. Smith's ECG Blog
SEPTEMBER 3, 2023
This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.
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Chest pain with serial ECGs – can you guess the sequence?
Dr. Smith's ECG Blog
JUNE 7, 2024
Written by Jesse McLaren A 45-year-old presented with 24 hours of intermittent chest pain. On it’s own this is nonspecific, but in the right context this could be diagonal occlusion (if active chest pain) or infero-posterior reperfusion (if resolved chest pain). #2 Can you guess the sequence?
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Quiz post: two patients with chest pain. Do either, both, or neither have OMI?
Dr. Smith's ECG Blog
MAY 29, 2024
Written by Pendell Meyers Two patients with acute chest pain. Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder. Two patients with chest pain. Do either, neither, or both have OMI and need reperfusion?
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A young woman with chest pain, cath lab activated
Dr. Smith's ECG Blog
APRIL 6, 2024
A young woman presented with acute chest pain. This case came from a friend whose sister was the patient. She knew I was interested in ECGs, so she took a photo of this one. This was her presenting ECG: What do you think? This is clearly Brugada phenotype. There is downsloping ST Elevation in V1 and V2.
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A 30-something with acute chest pain
Dr. Smith's ECG Blog
OCTOBER 3, 2024
I assumed it was a patient with acute chest pain. It was a man in his 30s with chest pain. This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. What do you think, Steve? Real or just fake?" What do YOU think? It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL.
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Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?
Dr. Smith's ECG Blog
MAY 27, 2024
Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chest pain as a “STEMI equivalent”[3] 3. But are there any other signs of Occlusion MI? Conduction disorders in the setting of acute STEMI.
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A 60-year-old diabetic with chest pain, cath lab activated
Dr. Smith's ECG Blog
SEPTEMBER 15, 2023
Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." K en G rauer gives a thorough explanation here: A 60 year old with chest pain == MY Comment , by K EN G RAUER, MD ( 9/15 /2023 ): == The 1st time that I saw APTA ( A rterial P ulse T ap A rtifact ) — I did not know what it was. That is not a STEMI.
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What happened after the Cath lab was activated for a chest pain patient with this ECG?
Dr. Smith's ECG Blog
MARCH 31, 2024
The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration. The pain was still active at the time of evaluation. See some relevant cases below: Chest pain with anterior ST depression: look what happens if you use posterior leads.
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A middle-aged man with acute chest pain.
Dr. Smith's ECG Blog
SEPTEMBER 1, 2023
A 50-something male had onset of chest pain 1 hour prior to ED arrival. Endorses some associated SOB, but denies back pain, fever, cough, chills, leg swelling, or other new symptoms. Always get serial ECGs in a patient with acute chest pain. It is constant, 9/10, left-sided CP that radiates into left arm and jaw.
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A man in his 40s with 3 days of stuttering chest pain
Dr. Smith's ECG Blog
MARCH 13, 2024
Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It started while he was at rest after finishing a workout.
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Acute chest pain and ST Elevation. CT done to look for aortic dissection.
Dr. Smith's ECG Blog
MARCH 9, 2024
Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. Due to the chest pain radiating into the patient's back, the ER physician ordered CTA chest to rule out aortic dissection. He had associated nausea, vomiting, and dyspnea.
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A 29 year old male with chest pain, ST Elevation, and very elevated troponin T
Dr. Smith's ECG Blog
APRIL 9, 2024
By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. How would you assess this ECG? What is your next step?
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Recurrent polymorphic ventricular tachycardia without chest pain: an unusual presentation of focal coronary artery spasm
The British Journal of Cardiology
MARCH 4, 2025
Coronary artery spasm (CAS), or Prinzmetal angina, is a recognised cause of myocardial ischaemia in non-obstructed coronary arteries which typically presents with anginal chest pain. The patient presented with recurrent palpitations and pre-syncope, with no chest pain.
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Act on mystery chest pain to reduce risk of heart attack, researchers urge
Medical Xpress - Cardiology
MARCH 29, 2024
Future heart attacks could be better prevented in people visiting their GP with unexplained chest pain, after Keele researchers developed the clearest picture yet of the factors that put them at higher risk. The research is published in the European Journal of Preventive Cardiology.
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Chest pain and new regional/reciprocal ECG changes compared to previous ECGs: code STEMI?
Dr. Smith's ECG Blog
NOVEMBER 27, 2023
Written by Jesse McLaren A 45 year old presented with two weeks of recurring non-exertional chest pain, now constant for an hour. Because of the ECG changes in a patient with chest pain, and with inferolateral hypokinesis on POCUS, the cath lab was activated. Below is old and then new ECG (old on top; new below).
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Chest Pain in a Middle-Aged Man
JAMA Cardiology
DECEMBER 17, 2024
A man in his mid-50s presented with chest pain lasting 30 minutes. The initial electrocardiogram showed type A preexcitation syndrome, with obvious ST-segment depression in leads V3 through V5 and positive delta wave. What would you do next?
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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.
Dr. Smith's ECG Blog
APRIL 14, 2024
A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike.
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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. His history included known heart failure with prior EF 18%, insulin dependent diabetes, and polysubstance abuse. Vitals were within normal limits except for tachypnea.
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Serial ECGs for chest pain: at what point would you activate the cath lab?
Dr. Smith's ECG Blog
AUGUST 11, 2024
Written by Jesse McLaren A healthy 75 year old developed 7/10 chest pain associated with diaphoresis and nausea, which began on exertion but persisted. Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. What do you think?
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An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain
Dr. Smith's ECG Blog
MARCH 19, 2024
The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. HPI: Abrupt onset of substernal chest pain associated with nausea/vomiting 30 min PTA.
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60 yo with chest pain: why the abnormal QRS and abnormal repolarization?
Dr. Smith's ECG Blog
AUGUST 16, 2024
Written by Pendell Meyers A man in his 60s presented with acute chest pain and normal vital signs. Here is his triage ECG: What do you think? The ECG shows massively hyperacute T waves of LAD OMI, plus WPW. V3-V5 also have the depressed HATW takeoff which qualifies them as the rare de Winter subtype of HATWs.
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114 ACC Chest Pain Pathway Validation
American College of Cardiology
MARCH 25, 2024
What is the validity the American College of Cardiology Expert Consensus Decision Pathway (ACC Pathway) for chest pain in a multisite US cohort?
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A man in his 50s with acute chest pain who is lucky to still be alive.
Dr. Smith's ECG Blog
JUNE 21, 2023
Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. The primary care physician there evaluated this patient and deemed the chest pain to be due to gastrointestinal causes. The ECG was also interpreted as normal by the primary care physician.
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50 year-old in remote rural community with chest pain and ‘normal’ ECG
Dr. Smith's ECG Blog
SEPTEMBER 8, 2023
A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you manage the patient?
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A 40-something with chest pain
Dr. Smith's ECG Blog
JANUARY 29, 2024
This was sent by Sam Ghali @EM_RESUS A 44 year old man presented with chest pain The tech came running with the ECG as the computer called "STEMI!" What do you think? Sam sent this to me and asked: "What do you think, Steve?" My answer: --Tough one! --But
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Three prehospital ECGs in patients with chest pain
Dr. Smith's ECG Blog
AUGUST 6, 2024
Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation. For 2 of the 3 patients — the cath lab was activated based on the ECG.
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Chest Pain in the ED: More Referrals for Cardiac Tests Not Tied to Better Outcomes
Med Page Today
MAY 23, 2024
(MedPage Today) -- For lower-risk patients with acute myocardial injury already ruled out for their chest pain, an increase in referrals for noninvasive cardiac testing (NICT) was not associated with improved outcomes, a retrospective cohort study.
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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.
Dr. Smith's ECG Blog
APRIL 22, 2024
A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. At times the pain does go to his left neck. It is a ssociated with mild dyspnea on exertion.
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Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!
Dr. Smith's ECG Blog
SEPTEMBER 11, 2024
No Chest Pain, but somnolent. The fact that this is syncope makes give it a far lower pretest probability than chest pain, but it was really more than syncope, as the patient actually underwent CPR and had hypotension on arrival of EMS. Here is the ED ECG (a photo of the paper printout) What do you think?
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A prehospital ECG in a patient with chest pain. The paramedics tell me it is normal.
Dr. Smith's ECG Blog
JULY 23, 2024
I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. They recorded a prehospital ECG at 2112 and said that it was “normal”. It had already been crumpled up and put in the waste basket. So I uncrumpled it: What do you think?
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Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?
Dr. Smith's ECG Blog
OCTOBER 18, 2023
Written by Jesse McLaren Four patients presented with chest pain. All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation.
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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.
Dr. Smith's ECG Blog
JUNE 23, 2024
He did not remember whether he had experienced any chest pain. Within a few days, the patient was extubated and was neurologically intact. However, he did not remember much from the day of the arrest. 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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Case 3-2025: A 54-Year-Old Man with Exertional Dyspnea and Chest Pain
The New England Journal of Medicine
JANUARY 22, 2025
A 54-year-old male athlete was evaluated at this hospital because of exertional dyspnea and chest pain. Physical examination revealed jugular venous distention and Kussmauls sign. A diagnosis was made.
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Three patients with chest pain and “normal” ECGs: which had OMI? Which were normal? And how did the Queen of Hearts perform?
Dr. Smith's ECG Blog
MARCH 14, 2024
Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think?
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Risk Prediction, CT Angiography, and CV Events in Chest Pain
American College of Cardiology
NOVEMBER 11, 2024
What is the prognostic effect of coronary computed tomography angiography (CCTA) versus usual care in patients with stable chest pain?
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Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.
Dr. Smith's ECG Blog
JANUARY 27, 2024
Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab? What do you think?
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Two patients with chest pain and RBBB: do either have occlusion MI?
Dr. Smith's ECG Blog
OCTOBER 17, 2024
Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Do either, both, or neither have occlusion MI? Vitals were normal.
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Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease
American College of Cardiology
MARCH 12, 2024
The goal of the DISCHARGE trial was to evaluate computed tomography (CT) compared with invasive coronary angiography among patients with stable chest pain and intermediate pretest probability of obstructive coronary artery disease.
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Responders to PCI for Angina Relief Identified by Chest Pain Type
Med Page Today
MAY 19, 2024
(MedPage Today) -- PARIS -- Whether a person had chest pains resolved by angioplasty hinged on the nature, not the severity, of their presenting symptoms, an ORBITA-2 analysis showed. Investigators found two groups more likely to benefit from.
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A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?
Dr. Smith's ECG Blog
MAY 23, 2023
Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset.
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50-year old with chest pain, “no ischemic changes”
Dr. Smith's ECG Blog
DECEMBER 29, 2023
Written by Jesse McLaren A previously healthy 50 year-old presented with 24 hours of intermittent exertional chest pain, radiating to the arms and associated with shortness of breath. In a previously healthy patient with new and ongoing chest pain, this is concerning for acute occlusion of the first diagonal artery.
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