Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

DAIC

JANUARY 3, 2024

Traditional methods of non-invasive ischemia testing (stress EKG , stress echo, SPECT , PET , direct-to-cath) can result in false negatives 20-30 percent of the time, which can lead to undetected disease, and false positives over 50 percent of the time, which can lead to unnecessary invasive procedures. Arbab-Zadeh, Heart Int 2012.

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Coronary Artery Disease Chest Pain Plaque Technology 59

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. She's had multiple PCI procedures.

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Chest Pain Pacemaker Ischemia Stent 111

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast.

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Chest Pain Blog Hospital Tachycardia 119

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.

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Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.

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Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), or basilar ischemia. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!)

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STEMI Document Blog Ischemia 114

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. His response: “subendocardial ischemia. Incidence of an acute coronary occlusion.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain. A mid 60s woman with history of hypertension, hyperlipidemia, and GERD called 911 for chest pain. It is also NOT the clinical scenario of takotsubo (a week of intermittent chest pain).

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Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

MARCH 2, 2019

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Ischemia b. ST depression: is it ischemia? It was a baseline finding in 62% of patients, usually due to LVH. Reference: Knotts RJ , Wilson JM, Kim E, Huang HD, Birnbaum Y.

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Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. The patient was in his 50s with history of hypertension, diabetes, seizure disorder, and smoking, but no known coronary artery disease. He had no further pain and went to bed that night with no complaints.

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Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

Dr. Smith's ECG Blog

APRIL 29, 2020

A recent similar case: A 40-something with chest pain. Instead, antiarrhythmic drugs such as amiodarone or ß-blockers may be needed — and/or treatment targeted to correcting ischemia. Acute ischemia? Is this inferior MI? Just as interesting is EKG 1, 24 minutes before the first: What do you think here?

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Cardiac Arrest Defibrillator Ischemia Tachycardia 52

DAIC

MAY 14, 2024

Together, the two companies will work to further the development and commercialization of Medis Quantitative Flow Ratio (Medis QFR), a non-invasive approach to the assessment of coronary physiology, as part of GE HealthCare’s interventional cardiology portfolio built around the Allia Platform.

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Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

DAIC

MAY 8, 2024

1 Atherosclerosis is a systemic disease that affects multiple vascular regions and is particularly severe in PAD patients, where up to 80 percent suffer from concurrent coronary artery disease (CAD), historically linked with a mortality rate exceeding 50 percent within five years. Journal of Vascular Surgery, Mar.

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Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

DAIC

APRIL 11, 2024

PCI is commonly used to open blocked arteries to treat significant myocardial ischemia , which occurs when the heart muscle does not get enough oxygenated blood. To test this strategy, researchers enrolled 1,606 patients treated for coronary artery disease at 15 centers in four countries.

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Plaque Heart Attack Heart attacks Coronary Artery Disease 111

MIBHS

OCTOBER 31, 2024

Heart Valve Disease If one or more heart valves are not functioning correctly, it can cause blood to flow backward, putting extra pressure on the heart, which may cause it to expand to compensate for the inefficiency. This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge.

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Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

DAIC

APRIL 2, 2025

Stone, MD Mount Sinai Health System tim.hodson Wed, 04/02/2025 - 15:26 March 31, 2025 Using intravascular imaging (IVI) to guide stent implantation during complex stenting procedures is safer and more effective for patients with severely calcified coronary artery disease than conventional angiography, the more commonly used technique.

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Stent Stents Outcomes Coronary Angiogram 40

Dr. Paddy Barrett

AUGUST 1, 2023

CT coronary angiography, in addition to a CT CAC, is arguably the best test for estimating whether someone has evidence of coronary artery disease and what that means for their near-term risk of a heart attack. This article is part 2 of a series on cardiac CT. I would say yes. For very good reason. And it matters.

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Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

MIBHS

OCTOBER 15, 2024

For example, if a coronary artery becomes blocked due to plaque buildup (a condition known as coronary artery disease), the heart muscle may not receive enough oxygen, leading to chest pain (angina) or, in more severe cases, a heart attack. CAD is one of the leading causes of heart attacks.

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Circulation Heart Attack Heart attacks Chest Pain 52

Dr. Paddy Barrett

NOVEMBER 28, 2023

In general, there is no debate here regarding the need for stenting a coronary artery. Share Stenting In Stable Coronary Artery Disease The real debate relates to the role of stenting in the setting of a severely narrow coronary artery outside the setting of a heart attack. Makes total sense.

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Stent Stents Heart Attack Heart attacks 53

Cardiometabolic Health Congress

MAY 10, 2024

In a study published by the American Heart Association, “Sex and Age Differences in the Association of Depression With Obstructive Coronary Artery Disease and Adverse Cardiovascular Events,” researchers investigated 3,237 patients (35% women) undergoing coronary angiography to evaluate for coronary artery disease (CAD).

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Coronary Artery Disease Obesity Chest Pain Ischemia 59

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

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Wellnest

DECEMBER 21, 2022

If you experience any symptoms, such as chest pain, dizziness, unusual tiredness or fatigue, shortness of breath, or irregular heartbeat, your doctor would want you to go for an ECG test to find out the underlying cause. An ECG or EKG monitor is used to detect diseases related to the heart.

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Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. There is no definite evidence of acute ischemia. (ie, The below ECG was recorded.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 130

Dr. Paddy Barrett

DECEMBER 5, 2023

Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. Whether stenting a narrowed coronary artery improves symptoms such as chest pain (angina) or shortness of breath is a very different question. N Engl J Med.

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Stent Stents Angina Heart Attack 59

Dr. Smith's ECG Blog

MARCH 6, 2019

A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath. Back to the case: The providers recognized persistent ischemia and likely occlusion, and discussed this with cardiology who took the patient immediately for cath. They opened it.

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STEMI Chest Pain Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Here I explain: First, you don't know for certain what the state of the artery was at the time of the ECG.

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Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 14, 2025

He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. He contacted EMS due to acute onset chest pain and feeling unwell and fatigued. He subsequently developed worsening chest pain. He was given ASA and sublingual NTG and taken to the ED.

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Chest Pain STEMI Myocardial Infarction Ischemia 105

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. No evidence for ischemia jumps out.

Chest Pain 101

Chest Pain Tachycardia Pacemaker Defibrillator 101

Dr. Smith's ECG Blog

JANUARY 24, 2025

The patient received three nitroglycerin tablets with significant "improvement" in his chest pain. Improved chest pain is unresolved chest pain. Improved chest pain is unresolved chest pain. I am commonly told, and I commonly read in the chart that chest pain is resolved.

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Chest Pain STEMI Risk Factors Coronary Artery Disease 123

CardiacWire

JANUARY 10, 2025

A recent study out of UCLA added to the growing body of evidence supporting AI-assisted CCTA as an alternative to SPECT for diagnosing obstructive coronary artery disease, especially in women. SPECT continues to be a first-line test to diagnose coronary ischemia, often instead of or before invasive coronary angiography.

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Coronary Artery Disease Ischemia Chest Pain Reimbursement 59

Frontiers in Cardiovascular Medicine

JANUARY 8, 2025

BackgroundPainful left bundle branch block (LBBB) syndrome is an uncommon disease that is defined as intermittent episodes of angina associated with simultaneous LBBB changes on an electrocardiogram (ECG) with the absence of flow-limiting coronary artery disease or ischemia on functional testing.

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Chest Pain Angina Coronary Artery Disease Blood Pressure 52

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.

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Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

DECEMBER 6, 2024

A 50-something man presented with worsening severe exertional chest pain which was just resolving as he had an ECG recorded in triage. Watch what happends as the heart recovers from its episode of ischemia. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute? Hard to tell. How can we know?

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Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis 106

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Written by Pendell Meyers A woman in her 70s with known prior coronary artery disease experienced acute chest pain and shortness of breath. The chest pain was described as severe pressure radiating to both shoulders. Here is her ECG within 30 minutes of PCI: Improved, but still with ischemia.

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Ischemia Tachycardia Chest Pain STEMI 118

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. link] Myers, A., &

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74