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.

Chest Pain 52

Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

MAY 6, 2019

The patient presented with chest pain. If it is STEMI, it would have to be RBBB with STEMI. 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. Cardioversion/defibrillation. Hypothermia.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 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. So there is definitely no STEMI, and the STE is normal. But after reading this blog, you all know that most OMI do NOT meet STEMI criteria. Defibrillated out of v fib in the cath lab.

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Chest Pain STEMI Blog Ischemia 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

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.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 23, 2014

He was defibrillated. Anterolateral STEMI. 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.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia STEMI 52

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

Ken Grauer, MD

JUNE 14, 2024

Prompt cath is therefore advised if the post-ROSC shows an acute STEMI. To Emphasize: The phenomenon of T-QRS-D is not needed in today's case to recognize the acute STEMI. Once the J-point is recognized in the chest leads ( RED arrows in leads V2,V3,V4 of Figure-2 ) — the marked ST elevation becomes obvious.

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Blog STEMI Cardiac Arrest Tachycardia 155

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. This is the response he got: Interventionist: "No STEMI, no cath. It is a STEMI equivalent.

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STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 Most recent echo showed EF of 60%. If the patient is at 1.8,

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

He was at the gym when he had the onset of chest pain. RBBB in acute STEMI has a very high mortality. This patient is 38 years old with hyperlipidemia. There is a wide S-wave in V6. Thus, there is right bundle branch block, which should never (unlike Left BBB) have any ST elevation.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Defibrillator STEMI 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. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

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. The case was reviewed by all parties, and it was stated correctly that the ECG does not meet the STEMI criteria.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

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.

Sudden Cardiac Death 52

Sudden Cardiac Death Defibrillator Arrhythmia Atrial Fibrillation 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. From Gue at al.

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Plaque Chest Pain Thrombosis Stenosis 52

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.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. It was from a patient with chest pain: Note the obvious Brugada pattern. Bicarb 20, Lactate 4.2,

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

This patient had many complaints including chest pain. The computer called this Acute STEMI What do you think? STEMI never has a very short QT. There is Bazett, Fridericia, Hodges, Framingham and Rautaharju -- see here at mdcalc: [link] If the ST Elevation here were due to STEMI, it would be an LAD Occlusion.

Chest Pain 52

Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. There is ST depression in II, III, and aVF that is concerning for reciprocal depression from high lateral STEMI in aVL, where there is some ST elevation. She collapsed and 911 was called; she was found pulseless. Exact rhythm during arrest is uncertain.

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Cardiac Arrest Tachycardia STEMI Chest Pain 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

The patient denied any chest pain whatsoever, and a troponin at zero and 2 hours were both undetectable. Implantable Cardioverter-Defibrillator ), with long-term potential for device-related complications from the ICD, including inappropriate shocks? Types 2 and 3 have been merged into Type 2 and look substantially different.

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Sudden Cardiac Death Heart Rhythm Article Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Written by Willy Frick A young woman with a history of paroxysmal nocturnal hemoglobinuria presented with acute substernal chest pain. Documentation does not indicate whether she had persistent chest pain during this time. Throughout this process, the patient had repeated VF and was defibrillated 8 times.

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Chest Pain Hospital Anatomy Aneurysm 66

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. Vital signs were within normal limits. She presented to the Emergency Department at around 3.5

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Ischemia Tachycardia Chest Pain STEMI 119

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Unfortunately, the ECG was interpreted as no significant change from prior , "no STEMI"!! Defibrillation was performed, and ROSC was achieved. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH.

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Cardiac Arrest STEMI Blog Ischemia 86

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. She was defibrillated perhaps 25 times. He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. SanzRuiz, R., Solis, J., & Verbeek, P.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75