Chest Pain, Defibrillator and Stents

A 50-something with chest pain.

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

Chest Pain Defibrillator STEMI Coronary Artery Disease

Chest pain and a "normal" ECG

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

Chest Pain STEMI Defibrillator Blog

Completely Wireless: First Concomitant Dual Chamber Leadless Pacemaker and Subcutaneous Defibrillator Implant

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

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Acute Chest pain in a 50-something, and a "Normal" ECG

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. 100% proximal LAD successfully stented. 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?

Chest Pain

Chest Pain STEMI Blog Ischemia

A man with chest pain off and on for two days, and "No STEMI" at triage.

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.

Chest Pain

Chest Pain STEMI Cardiogenic Shock Bradycardia

Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"

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.

Cardiac Arrest

Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator

Right Bundle Branch Block with Acute ST Elevation Seen Best on Prehospital ECG

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

He was at the gym when he had the onset of chest pain. A stent was placed, and the patient had an excellent outcome with no wall motion abnormality. 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

Cardiac Arrest Chest Pain Defibrillator STEMI

See what happens when hyperacute T-waves are missed

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.

Chest Pain

Chest Pain STEMI Cardiac Arrest Aneurysm

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

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. This was stented. Most recent echo showed EF of 60%. He had recently had a NonSTEMI.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

The First 60 Minutes of a Heart Attack: The Golden Hour

Wellnest

JULY 19, 2023

When a person experiences a heart attack or myocardial infarction, they may feel chest pain and other symptoms in different parts of their body. These issues can only be addressed in an ICCU (Intensive Coronary Care Unit) setting, where temporary pacemakers and defibrillators are available.

Heart Attack

Heart Attack Heart attacks Blood Pressure Myocardial Infarction

Recent MI at another facility. Now back in the ER with chest pain

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. The report describes heavy plaque in the proximal RCA by IVUS, but no lesions in the previously occluded RPL branch and no stent was deployed. Smith : The cath lab should be activated now!

Chest Pain

Chest Pain Hospital Anatomy Aneurysm

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

Chest Pain

Chest Pain Ischemia Plaque Stents

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA. 2:04 PM, post stent deployment You can see that even after complete restoration of flow, the ECG still looks terrible, V most of all. SanzRuiz, R., Solis, J., &

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Defibrillation was performed, and ROSC was achieved. Total proximal LAD occlusion was found and stented at angiography soon after the ECG above. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH.

Cardiac Arrest

Cardiac Arrest STEMI Blog Ischemia

Cardiovascular Update

A 50-something with chest pain.

Chest pain and a "normal" ECG

Completely Wireless: First Concomitant Dual Chamber Leadless Pacemaker and Subcutaneous Defibrillator Implant

Webinars

Acute Chest pain in a 50-something, and a "Normal" ECG

A man with chest pain off and on for two days, and "No STEMI" at triage.

Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"

Right Bundle Branch Block with Acute ST Elevation Seen Best on Prehospital ECG

See what happens when hyperacute T-waves are missed

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

The First 60 Minutes of a Heart Attack: The Golden Hour

Recent MI at another facility. Now back in the ER with chest pain

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Sometimes a patient is fortunate to have a cardiac arrest

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