Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. A repeat ECG was recorded with pain 2/10: Not much change.

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Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

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Chest Pain Blog Arrhythmia Critical Care 64

Dr. Smith's ECG Blog

MAY 6, 2019

The patient presented with chest pain. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. Is it Brugada pattern?

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin.

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Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. Today's patient is a 70-year old adult who called EMS because of new-onset chest pain , associated with nausea and shortness of breath. Who needs the cath lab?

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

AUGUST 17, 2019

Chris Mondie of the Newark Beth Israel Emergency Medicine Residency sent this case A 50-something man presented with acute chest pain. Defibrillated out of v fib in the cath lab. Here is his ECG: As you can see, the computer called it completely normal What do you think? 100% proximal LAD successfully stented.

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Chest Pain STEMI Blog Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 23, 2014

He was defibrillated. The formula results in 23.43, just above the 23.4 The patient was diagnosed with esophageal reflux and was being discharged by the nurse when he had a cardiac arrest. Here is his post resuscitation ECG: Now the diagnosis is obvious. Anterolateral STEMI.

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Chest Pain Cardiac Arrest Ischemia STEMI 52

HeartRhythm

SEPTEMBER 8, 2024

While in the hospital, he had witnessed ventricular fibrillation (VF) arrest for which he received external defibrillation. He had minimal in-stent restenosis on angiography but had only minimal cardiac enzyme elevation and did not have antecedent chest pain before either of his events.

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Defibrillator Pacemaker Chest Pain Coronary Artery Disease 40

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.

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Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

JULY 25, 2024

He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. Just as important is pretest probability: did the patient report chest pain prior to collapse? See these related cases: Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. They started CPR.

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Cardiac Arrest Ischemia Tachycardia Defibrillator 124

Dr. Smith's ECG Blog

JULY 14, 2023

He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device ( ResQPod ) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

DAIC

MARCH 1, 2024

It cannot be treated with a defibrillator and often leads to death. Ventricular fibrillation is a type of irregular heartbeat that can cause the heart to stop beating, but an electric shock from a defibrillator can trigger the beating again.

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Cardiac Arrest Electrocardiogram Defibrillator Electrophysiology 111

DAIC

JUNE 19, 2024

Patients may feel a fluttering in the chest, chest pain, shortness of breath and dizziness or lightheadedness as a result. The rapid heartbeat may only last for a few seconds, but during that time, the heart is beating so fast that it can’t get enough blood to the rest of the body.

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Tachycardia Cardiac Arrest Ablation Research 128

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below.

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Tachycardia Chest Pain Academic Arrhythmia 133

MIBHS

OCTOBER 31, 2024

Implantable Cardioverter-Defibrillator (ICD) to help manage dangerous heart rhythms. Coronary Artery Bypass Surgery for those with blocked arteries, improving blood flow to the heart muscle. Left Ventricular Assist Device (LVAD) , a mechanical pump that helps the heart pump blood more effectively.

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Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Dr. Smith's ECG Blog

JULY 14, 2010

A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. Before EMS arrived, she had "seizure activity" and became unresponsive. She was intubated.

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Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator 52

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

He was at the gym when he had the onset of chest pain. This patient is 38 years old with hyperlipidemia. EMS was activated and recorded the following ECG (scanned from a prehospital ECG, so the quality is not perfect): Notice the small Q wave in V1 followed by a very large R-wave, with a prolonged QRS. There is a wide S-wave in V6.

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Cardiac Arrest Chest Pain Defibrillator STEMI 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 history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

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. He required multiple defibrillations within a period of a few hours. What do you think?

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Ken Grauer, MD

JUNE 14, 2024

Retrospective questioning of the driver who brought this patient to the hospital revealed that he was having chest pain as the reason for presenting to the ED. A series of VFib episodes followed — each time with successful defibrillation. He became unconscious on arrival. ROSC ( R eturn O f S pontaneous C irculation ).

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All About Cardiovascular System and Disorders

MARCH 28, 2024

So this is a typical Brugada syndrome ECG, which can be easily mistaken for an acute myocardial infarction with ST elevation in anterior leads may be taken as STEMI if the person presents with chest pain for some other reason. The importance is that, it is an important cause of inappropriate discharge of defibrillators.

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Sudden Cardiac Death Defibrillator Arrhythmia Atrial Fibrillation 52

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. But artifact is "alive and well" — and learning to recognize it will amaze many of your colleagues ( and may serve to avoid an unnecessary defibrillation or two ). The rhythm terminated before it could be captured on 12-lead.

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Atrial Fibrillation Tachycardia Blog Chest Pain 81

Circulation: Arrhythmia and Electrophysiology

JANUARY 29, 2024

BACKGROUND:There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation.

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Cardiac Arrest Chest Pain Coronary Artery Disease Defibrillator 40

Dr. Smith's ECG Blog

OCTOBER 18, 2023

The chest pain quickly subsided. The patient was given chest compressions while waiting for the cardiac arrest team to arrive. After about 90 seconds of chest compressions she awoke. She spontaneously converted (Defibrillation was not performed). Are you worried about OMI in this case?

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Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. CPR was initiated immediately. This is a quiz.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

Written by Pendell Meyers, edits by Steve Smith A man in his 60s with history of hypertension and MI 10 years ago, with PCI, presented to an outside hospital complaining of chest pain that started while mowing the lawn. He was defibrillated immediately and had return of normal mental status.

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Chest Pain STEMI Cardiac Arrest Aneurysm 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. She was defibrillated and resuscitated.

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Plaque Chest Pain Thrombosis Stenosis 52

DAIC

MAY 9, 2024

People who do have symptoms may experience episodes of fainting, chest pain, shortness of breath or irregular heartbeats. HCM affects approximately 1 in every 500 individuals; however, a significant portion of cases remain undiagnosed because many people do not exhibit symptoms.

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Cardiomyopathy Pediatrics Quality of Life Sudden Cardiac Death 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. She was given CRT-D (Cardiac Resynchronization Therapy-Defibrillator). This was written by Magnus Nossen The patient is a female in her 50s. She presented with a one week hx of «dizziness» and weakness. She was feeling fine prior to the last seven days. She did admit to shortness of breath on exertion.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. Although in the context of chest pain such ST depression would be all but diagnostic of posterior OMI, one should make no conclusions in such an unusual case.

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Cardiac Arrest Bradycardia Chest Pain Ischemia 40

Dr. Smith's ECG Blog

APRIL 29, 2020

She was never defibrillated. A recent similar case: A 40-something with chest pain. As was seen in this case — defibrillation and/or overdrive pacing may be needed. She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. What do you think? Is this inferior MI?

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Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. The patient was defibrillated, and then taken to the nearest ED where ECG #1 was obtained ( Figure-1 ). Here is the initial ED ECG: This is pretty obviously and inferior posterior OMI, right?

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STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. The elevated troponin was attributed to either type 2 MI or to non-MI acute myocardial injury. There is no further workup at this time. Smith: Here is a case that was just texted to me today from a former resident. This patient ruled out for MI.

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. This middle-aged patient has a remote history of cardiac surgery as a young child for a "heart murmur". Her Apple Watch suddenly told her that she is in atrial fibrillation. She was on no medications. Methods.

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. EMS found the patient in VFib and performed ACLS for 26 minutes then obtained ROSC.

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Ischemia Arrhythmia Defibrillator Chest Pain 40

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. At cath, he immediately had incessant Torsades de Pointes requiring defibrillation 7 times and requiring placement of a transvenous pacer for overdrive pacing at a rate of 80. Most recent echo showed EF of 60%. He had recently had a NonSTEMI.

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STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. Comment by K EN G RAUER, MD ( 2/11 /2023 ): = Today’s case is from a patient with “many complaints”, including chest pain — and, an ECG that raised concern about acute anterior OMI. Treatment is by ICD ( implantable cardioverter defibrillator ).

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52