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.

Chest Pain 122

Chest Pain STEMI Myocardial Infarction Ischemia 122

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.

Chest Pain 135

Chest Pain Diabetes STEMI Blog 135

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.

Chest Pain 128

Chest Pain STEMI Stenosis Myocardial Infarction 128

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.

Chest Pain 122

Chest Pain STEMI Hospital 122

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?

Chest Pain 83

Chest Pain Electrocardiogram 83

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.

Chest Pain 110

Chest Pain STEMI Ischemia Myocardial Infarction 110

American College of Cardiology

NOVEMBER 5, 2024

ACC's Chest Pain Center Accreditation is designed to help facilities to establish consistent, high-quality processes for the most efficient and effective acute coronary syndrome (ACS) care.

Chest Pain 40

Chest Pain Article 40

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).

Chest Pain 110

Chest Pain STEMI Ischemia Anatomy 110

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.

Chest Pain 108

Chest Pain Angina Echocardiogram Myocardial Infarction 108

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.

Chest Pain 117

Chest Pain Pericarditis Aortic Echocardiogram 117

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?

Chest Pain 100

Chest Pain STEMI Bradycardia Stent 100

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?

Chest Pain 108

Chest Pain Pericarditis Blog Tachycardia 108

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.

Chest Pain 98

Chest Pain Cardiac Arrest STEMI Defibrillator 98

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.

Chest Pain 91

Chest Pain Heart attacks Heart Attack Research 91

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.

Chest Pain 111

Chest Pain STEMI Blog 111

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chest pain. He was eating lunch when he had sudden onset chest pressure, 9/10, radiating to his back, with sweating and numbness in both hands.

Chest Pain 130

Chest Pain Tachycardia STEMI Blog 130

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?

Chest Pain 129

Chest Pain Blog STEMI 129

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.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

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.

Chest Pain 119

Chest Pain Ischemia Myocardial Infarction Ultrasound 119

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.

Chest Pain 80

Chest Pain Outcomes 80

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

Chest Pain 96

Chest Pain STEMI Blog Outcomes 96

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. So a patient with high pretest probability (prior CABG with new chest pain), had new ECG changes showing posterior OMI.

Chest Pain 114

Chest Pain STEMI Atrial Flutter Ischemia 114

Dr. Smith's ECG Blog

FEBRUARY 14, 2024

A 41-year-old male who presents to the emergency department with chest pain. Patient reports approximately 2 hours prior to arrival he developed a sharp chest pain that radiates into his left arm and left lower leg. Describes the radiating pain as numbness/tingling. No shortness of breath. No recent travel.

Chest Pain 110

Chest Pain Angina Ischemia Outcomes 110

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.

Chest Pain 117

Chest Pain Myocardial Infarction Anatomy Angina 117

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.

Chest Pain 111

Chest Pain Myocardial Infarction Stent Stents 111

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?

Chest Pain 114

Chest Pain Aneurysm Stent Stents 114

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?

Chest Pain 115

Chest Pain Critical Care STEMI Stent 115

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?

Chest Pain 64

Chest Pain Article 64

Dr. Smith's ECG Blog

MARCH 22, 2024

Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown: What do you think? What do you think?

Chest Pain 114

Chest Pain STEMI Bradycardia Ischemia 114

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.

Chest Pain 119

Chest Pain STEMI Electrocardiogram Ischemia 119

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.

Chest Pain 66

Chest Pain Hospital 66

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.

Chest Pain 59

Chest Pain Angina Angioplasty 59

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?

Chest Pain 117

Chest Pain STEMI Aneurysm Stent 117

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.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

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?

Chest Pain 119

Chest Pain STEMI Outcomes Electrocardiogram 119

Dr. Smith's ECG Blog

DECEMBER 26, 2023

I went to the patient's chart: Elderly woman with stuttering chest pain and SOB, and dizziness. I was reading ECGs on the system and saw this one, and instantly knew the probable ECG diagnosis: What do you think? What do you think now? This is a very typical ECG for Hypertrophic Cardiomyopathy.

Chest Pain 93

Chest Pain Cardiomyopathy Blog AFIB 93

Dr. Smith's ECG Blog

MARCH 10, 2025

Written by Jesse McLaren A 50 year old presented to triage with one hour of chest pain, and the following ECG labeled normal by the computer (GE Marquette SL) algorithm. What do you think? Theres normal sinus rhythm, first degree AV block, early R wave, normal voltages. Here is her ECG: What do you think?

Chest Pain 89

Chest Pain Outcomes STEMI Electrocardiogram 89