Remove Chest Pain Remove Critical Care Remove Stents
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A 50-something with chest pain.

Dr. Smith's ECG Blog

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.

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A prehospital ECG in a patient with chest pain. The paramedics tell me it is normal.

Dr. Smith's ECG Blog

I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. I took the patient to the critical care area and questioned him more on the way. The pain had been intermittent until an hour before arrival, when he called 911. It was opened and stented.

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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

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.

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A 50-something with acute chest pain, a computer "Normal" ECG, and a HEART score of 3 (low risk)

Dr. Smith's ECG Blog

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. It was stented with good results. An ECG was immediately recorded: Computer read: Normal ECG What do you think? There is ST depression in V1-V3.

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Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

Dr. Smith's ECG Blog

The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction. This EKG was recorded as part of a standing order for critical care. In the setting of prior stenting and reduced left ventricular ejection fraction, would pursue a heart team revascularization approach Syntax score 28.5,

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A 50-something woman with chest pain and 2 "normal" ECGs at triage

Dr. Smith's ECG Blog

I activated the cath lab and brought her to the critical care area. Angiogram showed a distal RCA occlusion which was stented. Echo showed inferior wall motion abnormality.

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A Middle Aged Male diagnosed with Gastroesophageal Reflux

Dr. Smith's ECG Blog

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.