Dr. Smith's ECG Blog

MARCH 8, 2021

He was a 30-something with chest pain. A male in his 30's complained of sudden severe substernal chest pain. Shoulder pain after lifting a heavy box de Winter's -- they remained stable for 30 minutes with many ECGs. Here is one case of a patient I saw. But we find that this is unusual. They are too narrow.

Chest Pain 52

Chest Pain STEMI Ischemia Critical Care 52

Dr. Smith's ECG Blog

JULY 16, 2022

This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain. The initial troponin I returned at 1500 ng/L and another ECG was recorded as the patient complained of 9/10 chest pain at 10 hours after the first Now the T-wave in III is fully upright, suggesting re-occlusion.

Chest Pain 52

Chest Pain Bradycardia Blog Critical Care 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Submitted and written by Alex Bracey, with edits by Pendell Meyers and Steve Smith: I was walking through the critical care section of the ED when I overheard a discussion about the following ECG. The patient was given fentanyl initially for chest pain with minimal effect and then vomited which was followed by zofran and famotidine.

Chest Pain 52

Chest Pain Critical Care Article Pacemaker 52

Dr. Smith's ECG Blog

DECEMBER 23, 2022

The patient was otherwise healthy, had no past history, and had never had chest discomfort before. I immediately activated the critical care team and walked the patient to the critical care area, our "Stabilization Room." There are relatively large T-waves in V4-V6. Let's record another one."

Chest Pain 52

Chest Pain Critical Care STEMI Plaque 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. We brought the patient into one of our critical care rooms and immediately got more history while recording this repeat ECG: The STE in I has greatly diminished or entirely disappeared. No prior available.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

Dr. Smith's ECG Blog

NOVEMBER 8, 2022

The patient had come to the ED for SOB, but without any chest pain. He was moved to the critical care area due to his EKG. Other cases of Pulse Tapping Artifact: Acute chest pain and a bizarre ECG Bizarre (Hyperacute??) Solution : repeat the ECG, but move the left leg electrode. His potassium returned at 1.3

Article 52

Article Chest Pain Blog Myocardial Infarction 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

There was no chest pain. Later, I was working in the ED and a patient was moved from a regular room to the critical care area due to recurrent hypotension. The patient was now under my care. But today's patient had no chest pain. In reviewing the case, I saw the ECG and recognized it as the same one.

Pulmonary 40

Pulmonary Chest Pain Hypertension Tricuspid 40

Dr. Smith's ECG Blog

AUGUST 13, 2020

Instead, he complained of left chest "itchiness". He was brought to the critical care area where these rhythms were seen on the monitor: Wide complex tachycardia with no apparent P-waves, and very irregular Consistent with atrial fibrillation with aberrancy A Regular wide complex tachycardia. LV Aneurysm?

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Chest Pain 134

Chest Pain Defibrillator STEMI Coronary Artery Disease 134

Dr. Smith's ECG Blog

JUNE 23, 2024

Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. He did not remember whether he had experienced any chest pain. At his family's request, he was transferred to a hospital closer to his home to continue care. He was admitted to cardiology.

Chest Pain 117

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 117

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. Edits by Willy Frick.

Chest Pain 63

Chest Pain Blog Critical Care Arrhythmia 63

Dr. Smith's ECG Blog

APRIL 29, 2023

A 50-something with no previous cardiac history and no risk factors presented to the ED with acute chest pain (pressure) that radiated to the left arm. But even without these additional findings — the "Must Recognize" ECG pattern in this patient with new chest pain — is the unmistakeable shape of the ST depression in leads V2 and V3!

Chest Pain 52

Chest Pain Blog Stenosis Critical Care 52

DAIC

MARCH 7, 2024

The recent change in guidelines from the ACC and AHA are now clear that cardiac CT is the Level 1A evidence recommended test for diagnosis of stable and acute chest pain,” said Chaim Lotan, MD, professor at Hadassah-Hebrew University, in a written statement from Arineta. Workflow improvements.

Technology 111

Technology Document Cardiovascular Imaging Cancer 111

Dr. Smith's ECG Blog

JUNE 2, 2023

She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED.

Tachycardia 96

Tachycardia Cardiomyopathy Article Electrocardiogram 96

Dr. Smith's ECG Blog

MAY 5, 2022

He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. They recommended repeating his ECG and awaiting troponin since the patient did not have any chest pain. He complained of generalized weakness and left lower extremity numbness. What is it?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. Crit Care Med. 1991 May;19(5):694-9 Objective: To evaluate the efficacy and safety of potassium replacement infusions in critically ill patients. Setting: Multidisciplinary critical care unit. Most recent echo showed EF of 60%.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. In the ED he had some continued chest pain and hypotension. Here was his ECG: There are inferior and lateral Q-waves with T-wave inversion in the corresponding leads.

Chest Pain 40

Chest Pain STEMI Pericarditis Ultrasound 40

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. The blood pressure was 170/100 in the critical care area. Which patient needs a CT Scan? Denies SOB.

Chest Pain 104

Chest Pain STEMI Aortic Ultrasound 104

Dr. Smith's ECG Blog

DECEMBER 29, 2024

Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. So let's pretend this is acute chest pain. 20 cases with pseudonormalization Case continued The patient was moved to the critical care area, and cardiology was consulted.

Stents 65

Stents Stent Chest Pain Angina 65

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

1) Very high initial troponin of 45,000 ng/L 2) A full day of chest pain 3) Q-waves on the ECG, with some T-wave inversion Here is one frame of the CT scan which includes the heart: Can you spot the infarct? There is STE in V5-6. There are new Q-waves in aVL, V5-6. SUBACUTE) OMI, that would result in an undesirable delay.

Blog 62

Blog Chest Pain Myocardial Infarction Critical Care 62

Dr. Smith's ECG Blog

MARCH 8, 2025

Just a few weeks ago, I took care of a patient who had ostial RCA OMI (TIMI 0 at cath) and his only complaint was syncope! He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. Multidisciplinary critical care management of electrical storm. link] Jentzer, J. Kashou, A.

Cardiomyopathy 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74