Dr. Smith's ECG Blog

MAY 16, 2023

Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chest pain". Anxiety is a common cause of chest pain with tachycardia.

Chest Pain 52

Chest Pain Pericarditis Tachycardia STEMI 52

Dr. Smith's ECG Blog

MAY 19, 2022

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. Ct coronary angiogram showed normal coronary arteries. He typically runs 4 to 8 miles per day.

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

JUNE 5, 2024

The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder.

Chest Pain 121

Chest Pain Blog Cardiac Arrest Cardiomyopathy 121

Dr. Smith's ECG Blog

MAY 24, 2022

A 30-something male presented in the middle of the night with several hours of sharp, non-radiating, left sided chest pain. CT coronary angiogram is excellent , but is rarely available outside of business hours, and hardly ever at night. He is a smoker and has some family history of early MI.

Chest Pain 52

Chest Pain Blog Coronary Angiogram Coronary Artery Disease 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

The medics stated he had been nauseated and diaphoretic, but he did not have any chest pain or SOB. And especially suspect Old MI when the patient gives a history of MI and has no chest pain or SOB. He had a prehospital ECG. He was ambulatory at the scene. He has a history of STEMI and heart failure.

Aneurysm 114

Aneurysm Chest Pain Echocardiogram STEMI 114

Open Heart

MAY 2, 2023

Availability of systematic coronary physiology might result in more homogeneous interpretation and management strategy compared with ICA alone. Methods 150 coronary angiograms from patients with stable chest pain were presented independently to three NICs, three ICs and three CSs.

Physiology 52

Physiology Coronary Artery Bypass Graft Coronary Angiogram Chest Pain 52

Ken Grauer, MD

FEBRUARY 24, 2023

Hospital evaluation for this patient was negative for an acute coronary syndrome ( ie, CT coronary angiogram was normal — troponin was not elevated — and Echo was negative, with no sign of pericardial effusion ). I interpreted the ECG in Figure-1 as follows: The rhythm is sinus at ~65/minute.

Pericarditis 78

Pericarditis Blog Chest Pain Coronary Angiogram 78

Dr. Smith's ECG Blog

JULY 2, 2023

Chest pain or discomfort) What do you think? The total duration of chest pain was 30-45 minutes. Outcome The only followup we got was that the patient is undergoing Coronary Bypass (CABG) of LAD, 2nd Obtuse Marginal, and Left Posterolateral coronaries.

Chest Pain 52

Chest Pain Angina Coronary Angiogram Blog 52

Circulation

NOVEMBER 11, 2024

Case presentation:A 64-year-old man presented with one day of chest pain. A repeat coronary angiogram was unremarkable. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024. Initial evaluation showed elevated cardiac enzymes (CE) and normal eosinophil count.

Myocardial Infarction 40

Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain 40

Ken Grauer, MD

JULY 15, 2023

CT coronary angiogram — No obstructive coronary disease. CT coronary angiogram showed no obstructive coronary disease. But immediate resolution of chest pain once VT was converted — and — the normal CT coronary angiogram — essentially ruled out acute coronary disease as the cause.

Blog 78

Blog Coronary Angiogram Cardiomyopathy Ischemia 78

EMS 12-Lead

JULY 24, 2023

But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chest pain was a little more intense, and the needed recovery period was longer in duration. It’s judicious, then, to arrange for coronary angiogram. Coronary Angiogram 1.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

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. All electrocardiograms (ECGs) and coronary angiograms were blindly analyzed by experienced cardiologists.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

EMS 12-Lead

MAY 20, 2022

Cardiology felt her chest pain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. Type II MI), however decided to pursue coronary angiogram out of an abundance of caution. Below are two examples of this.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

JUNE 20, 2020

He denied chest pain or dyspnea throughout. Discussion Thus, no further ECGs were recorded and there was no angiogram or stress test or CT coronary angiogram. No previous study for comparison. Clinical Course: - He had no events on cardiac monitoring overnight. -

STEMI 52

STEMI Hospital Coronary Angiogram Dysrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Paddy Barrett

AUGUST 1, 2023

CT Coronary Artery Calcium Score Scan CT Coronary Artery Calcium Score CT Coronary Angiogram As you can see from the above images, the CTCA provides far more anatomical detail. Regardless, if you present with chest pain and get a stress test instead of a CTCA, you are arguably getting an inferior test.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

DAIC

APRIL 2, 2025

Patients with coronary artery diseaseplaque buildup inside the arteries that leads to chest pain, shortness of breath, and heart attackoften undergo PCI, a non-surgical procedure in which interventional cardiologists use a catheter to place stents in the blocked coronary arteries to restore blood flow.

Stents 40

Stents Stent Outcomes Coronary Angiogram 40

Dr. Paddy Barrett

JANUARY 30, 2024

We look directly at the coronary arteries using a cardiac CT scan. Subscribe now Cardiac CT There are two types of cardiac CT: CT Coronary Artery Calcium (CAC) Scan CT Coronary Angiogram (CTCA). The CAC scan looks for deposits of calcium in the areas of the coronary arteries as a proxy marker for plaque.

Heart Disease 95

Heart Disease Heart Attack Heart attacks Plaque 95

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior.

Tachycardia 138

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 138

Dr. Smith's ECG Blog

JUNE 19, 2023

The patient’s chest pain spontaneously resolved before he was evaluated and has a repeat ECG obtained at 22:12 obtained shown below. In context, of course, it is clear that the patient is reperfusing, as pain has dissipated and the diagnostic findings of OMI have become more nonspecific. This ECG is more difficult.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Anish Koka

MAY 16, 2023

Knowledge of this fundamental pillar of biology should drive how cardiologists approach men and women being evaluated for the presence of significant coronary disease. Atypical angina is classified as having any two of the three symptoms, and non-anginal pain any one of the three symptoms. versus 66.3%; P =0.004), older age (62.4±7.9

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Here is the coronary angiogram: A distal thrombotic right coronary artery (RCA) occlusion ! In a patient with ongoing, severe chest pain — the subtle-but-real ST-T wave changes are "dynamic" indication of an ongoing acute cardiac event — therefore prompting the need for cardiac cath!

STEMI 52

STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

BoardVitals - Cardiovascular

MAY 1, 2017

He has never had any chest pain. He has no known prior medical history and does not take any medications. He complains of occasional shortness of breath on walking more than 2 blocks. He has never smoked and denies any alcohol or drug abuse history. He was adopted and does not know anything about his parents or siblings.

Cardiomyopathy 52

Cardiomyopathy Sudden Cardiac Death Bicuspid/Mitral Electrocardiogram 52

Frontiers in Cardiovascular Medicine

DECEMBER 20, 2024

The left and right coronary arteries were slender and narrow, which was relieved after the injection of 100g nitroglycerine through the left coronary artery. After performing a coronary angiogram, the patient was given long-acting nitrates and calcium channel blockers orally, and her chest pain did not reoccur.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Coronary Angiogram Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Case 1: 20-something woman with chest pain Case 2: 50-something man with chest pain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chest pain. Angiogram Door to balloon time was 120 minutes (much too long) because of time taken for a CT. Denies SOB.

Chest Pain 104

Chest Pain STEMI Aortic Ultrasound 104

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 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. S. Venkatesan MD

JANUARY 22, 2025

I don’t understand how the curve of non-cardiac chest pain trespasses in the middle of a Troponin race (False positives? Mind you, even a coronary angiogram will not bail you out in terms of decision-making and risk prediction. See how the Kaplans diverge dramatically depending upon the hsTnT levels.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Anatomy Angina 52

Dr. Smith's ECG Blog

MARCH 9, 2025

A 62 year old man with hyperlipidemia presented to a rural emergency department with 7 hours of 3/10 chest pain. Heitner et al found that in 14% of patients with NSTEMI, a blinded interventional cardiologist interpreting coronary angiograms identified a different culprit artery than CMR ( [link] ).

Ischemia 87

Ischemia Blog STEMI Coronary Angiogram 87