Chest Pain Coronary Angiogram Tachycardia 
Dr. Smith's ECG Blog
MAY 10, 2023
A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.
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". Here is his triage ECG: What do you think?
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.
Ken Grauer, MD
JULY 15, 2023
Given the rapid rate of the tachycardia and the amorphous shape of the QRS — the decision was made to sedate the patient and cardiovert. This phenomenon may sometimes be seen following an episode of a sustained tachycardia — in which marked ST-T wave abnormalities not due to infarction may be seen for a period of hours, or even days!
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. A 12 Lead ECG was captured on her arrival.
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.
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. Ken notes AV dissociation.
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