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. EMS recorded the following ECG: What do you see? The computer read "Right Bundle Branch Block" There is RBBB and LAFB, which can make it difficult to see the end of the QRS.

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Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Circulation. Isn't it amazing?? 2001;104:636–641.

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Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin.

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Dr. Smith's ECG Blog

DECEMBER 14, 2016

A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. It was not relieved by anything. He had no previous medical history.

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Chest Pain STEMI Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Of course this depends on many factors: 1) duration of occlusion, 2) whether full or near occlusion with zero flow or some flow -- the flow in the artery is the critical factor, measured by "TIMI" flow, 3) presence of collateral circulation and others. Upon questioning patient, he denies having any chest pain or chest tightness of any sort.

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Chest Pain Coronary Artery Bypass Graft Pericarditis Blog 52

MIBHS

OCTOBER 15, 2024

This is where coronary circulation comes into play. Coronary circulation refers to the movement of blood through the network of coronary arteries and veins that supply the heart muscle (myocardium) itself. Step-by-Step Breakdown of Coronary Circulation 1.

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Dr. Smith's ECG Blog

AUGUST 3, 2017

A 70-year-old man calls 911 after experiencing sudden, severe chest pain. Circulation. Does routine use of the 15-lead ECG improve the diagnosis of acute myocardial infarction in patients with chest pain? This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! This is his 12-Lead ECG: What do you think?​

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Chest Pain Myocardial Infarction STEMI Ischemia 52

Circulation: Cardiovascular Imaging

NOVEMBER 20, 2023

Circulation: Cardiovascular Imaging, Volume 16, Issue 11 , Page e015800, November 1, 2023. 1.39];P=0.669) did not differ significantly between groups.CONCLUSIONS:In patients with stable chest pain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA. were referred to CCTA and 22.5%

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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. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS.

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Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4137144-A4137144, November 12, 2024. The patient’s chest pain (CP) was not alleviated with initial revascularization of his left circumflex (LCx) ST, requiring PCI to his right coronary artery (RCA) chronic total occlusion (CTO). We present a case of reinfarction from ST.

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Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 3, 2025

Circulation: Cardiovascular Quality and Outcomes, Ahead of Print.

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Chest Pain Outcomes Coronary Artery Disease Myocardial Infarction 40

DAIC

MAY 8, 2024

5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. 5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. Circulation, vol. The Lancet, vol. 10390, May 2023, pp. 22, 30 Nov.

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Circulation: Genomic and Precision Medicine

SEPTEMBER 27, 2023

Circulation: Genomic and Precision Medicine, Volume 16, Issue 5 , Page 442-451, October 1, 2023. Background:Patients with de novo chest pain, referred for evaluation of possible coronary artery disease (CAD), frequently have an absence of CAD resulting in millions of tests not having any clinical impact.

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Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.

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Chest Pain Myocardial Infarction Blog Stents 130

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4134796-A4134796, November 12, 2024. Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease.

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Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Angiography usually reveals an absence of collateral circulation to the infarct zone. But in the other half of this 30% ( ie, in ~15% of all patients with MI ) — although these patients found on follow-up ECG to have had infarction did not have chest pain — they did have "something else" thought to be associated with their MI.

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Circulation: Cardiovascular Quality & Outcomes

MAY 23, 2024

Circulation: Cardiovascular Quality and Outcomes, Ahead of Print.

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DAIC

MARCH 28, 2024

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Gulati M, Levy PD, Mukherjee D, et al. 2021 Nov 30;144(22):e368-e454.

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Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Circulation 2014 2. Echo showed new anterior regional wall motion abnormality and decrease EF from 60% to 45%.

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STEMI Chest Pain Myocardial Infarction Blog 121

Dr. Smith's ECG Blog

DECEMBER 11, 2023

See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. This is different from nitroglycerin which produces vasodilation and can improve by pain improving myocardial perfusion. You do not need to be better than the Queen of Hearts at EKG to understand that refractory chest pain NEEDS CATH NOW.

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Circulation

DECEMBER 10, 2023

Circulation, Volume 148, Issue 24 , Page e281-e281, December 12, 2023.

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Chest Pain Circulation 49

Circulation: Cardiovascular Imaging

JANUARY 15, 2024

Circulation: Cardiovascular Imaging, Volume 17, Issue 1 , Page e000082, January 1, 2024.

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Dr. Smith's ECG Blog

JULY 22, 2023

He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. Circulation, 117, 1890–1893. [3]: See below for PM Cardio digitized version of this. PM Cardio digitized version.

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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

FEBRUARY 8, 2015

Marcus, G. Harvard Medical School, Boston, Massachusetts, USA. Metoprolol and atenolol are overwhelmingly beta-1 cardioselective. Beta-1 blockade decreases inotropy and chronotropy and has no vasoconstrictive effects. Only beta-2 blockade (e.g., Philippides, G. Henry Ford Hospital. Philippides, G. Henry Ford Hospital.

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Tachycardia Chest Pain Pharmacology Myocardial Infarction 52

DAIC

MARCH 1, 2024

Those who had ventricular fibrillation were more likely to be younger, have had coronary artery disease or experienced chest pain as a warning symptom. “We We plan to continue to study this AI method to learn how it could be used in a clinical setting.”

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Dr. Smith's ECG Blog

JANUARY 2, 2016

A middle aged male presented with chest pain. In LVH, T-wave inversions are usually much more assymetric , like these (Figure 2): Acute Chest pain, but baseline ECG. And sometimes the lateral T-wave is biphasic, with the terminal portion more upright (Figure 3): Acute chest pain. Baseline EKG, no MI.

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Dr. Smith's ECG Blog

DECEMBER 6, 2022

A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. So they took the patient urgently to cath: 100% occlusion of inferior obtuse marginal branch of the circumflex, with collateral circulation. What do you think?

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DAIC

JANUARY 25, 2024

More than 8 million Americans visit hospital emergency departments experiencing chest pain every year. “In the future, patients with coronary inflammation can be identified by the CaRi-Heart technology and treated by our FDA -approved LODOCO 0.5 mg tablets.”

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Ken Grauer, MD

MARCH 7, 2023

But, in a patient who presents to the ED for new chest pain — seeing these subtle findings that are localized to leads V2- thru -V4 should at the least make you consider acute posterior OMI ( O cclusion-based MI ) — until you prove otherwise. To EMPHASIZE: These are subtle findings. What do YOU think?

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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

The history is concerning ( This patient was awakened from sleep by chest pain that persisted for several hours — on a background of intermittent CP in recent weeks ). The ECG changes seen between the initial ECG and the repeat ECG after NTG — are undeniable! Nor was there a challenge to look for coronary spasm.

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Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4119267-A4119267, November 12, 2024. Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chest pain for 2 months.

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Circulation: Arrhythmia and Electrophysiology

DECEMBER 21, 2023

Circulation: Arrhythmia and Electrophysiology, Ahead of Print. Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02) BACKGROUND:Inflammation may promote atrial fibrillation (AF) recurrence after catheter ablation. 2.02];P=0.89). 1.99];P=0.55).CONCLUSIONS:Colchicine

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MIBHS

OCTOBER 31, 2024

Regular physical activity can strengthen the heart and improve circulation. Lifestyle Changes Making certain lifestyle adjustments can also improve heart function and reduce the risk of further enlargement: Maintain a healthy diet low in salt and saturated fats. Avoid smoking and limit alcohol intake.

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Dr. Smith's ECG Blog

MARCH 9, 2013

This male in his 40's had been having intermittent chest pain for one week. He awoke from sleep with crushing central chest pain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric.

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DAIC

MARCH 11, 2024

a med tech company dedicated to helping patients with persistent ischemic heart disease, has announced the treatment of the first patient with the A-FLUX Reducer System, a treatment for patients with angina or chest pain. Circulation. VahatiCor, Inc., Angina is often caused by reduced blood flow to the heart. 27 May 2021.

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Dr. Smith's ECG Blog

OCTOBER 26, 2011

This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.

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