Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

It has been estimated that in the aggregate, they occur at a rate of about 3 per 1000 patients with acute MI, and most of these events occur in patients with STEMI. A mong patients with STEMI, ventricular septal rupture is the most common and free wall rupture is the least common.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

OCTOBER 26, 2011

This 57 yo diabetic male presented with generalized fatigue, myalgias, and arthralgias , mild subjective fever and chills, and nausea. He also stated his arms and head feel "heavy" and he had a headache, dry heaves, and dizziness, and some "indigestion" in his chest "like acid". He had been awakened by cough at 3 AM 2 days earlier.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

AUGUST 30, 2020

This ECG was texted to me with the message "A 31 year old with Diabetes and HTN complains of bilateral arm tingling and headache." The computer calls it a STEMI. If it was chest pain it would be more difficult to go with my gut on that." Never chest pain but had to treat as hypertensive emergency.

Diabetes 52

Diabetes Chest Pain Hypertension STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Pulse was 115, BP 140/65, and afebrile He was found to have cellulitis and to be in diabetic ketoacidosis, with bicarb of 14, pH of 2.27, glucose of 381, anion gap of 18, and lactate of 2.2 While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain.

Chest Pain 117

Chest Pain Ischemia Echocardiogram Myocardial Infarction 117

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast.

Chest Pain 119

Chest Pain Blog Hospital Tachycardia 119

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information: A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed.

STEMI 52

STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

AUGUST 26, 2019

Written by Pendell Meyers A woman in her 70s with diabetes, hypertension, and hyperlipidemia suddenly developed nausea, diaphoresis, and brief syncope while eating at a restaurant. She did not report any chest pain or pressure. This one likely does meet STEMI criteria in II, III, and aVF. Let me know what happens."

Chest Pain 52

Chest Pain STEMI Biomarkers Article 52

Dr. Smith's ECG Blog

DECEMBER 29, 2018

Written by Pendell Meyers A male in his 50s with history of HTN, DM, HLD presented with chest pain of less than one hour duration. Here is a repeat ECG 45 minutes later with persistent chest pain: Obviously progressing into a clear STEMI. Meets formal STEMI criteria in V2-V3.

Chest Pain 52

Chest Pain STEMI Diabetes Hypertension 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Plan was for admission for chest pain workup.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 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. The patient was in his 50s with history of hypertension, diabetes, seizure disorder, and smoking, but no known coronary artery disease. He went inside and sat down, and the pain slowly subsided over the course of about 30 minutes.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

Dr. Smith's ECG Blog

FEBRUARY 14, 2020

Written by Pendell Meyers, sent by Anonymous A man in his 50s with history of type 2 diabetes, HTN, and HLD presented with one day of off and on chest / upper abdominal pain. It had awoken him from sleep earlier, and he described it as "gas pain," located in the upper epigastrium and radiating upwards.

Chest Pain 52

Chest Pain STEMI Anatomy Risk Factors 52

Dr. Smith's ECG Blog

JUNE 17, 2017

The above is what I thought when I saw this, so I went to the chart and found this history: A type I diabetic aged approximately 35 years old presented with chest pain, nausea, vomiting and diffuse abdominal pain. The possibility of anterior STEMI was not noticed during patient care. pH = 7.17, pCO2 = 24, HCO3 = 8.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Stents 52

Dr. Smith's ECG Blog

APRIL 20, 2018

female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chest pain for the past four hours. While she was in her bed at home, she had sudden onset of left sided chest pain that radiated to her shoulder. The pain was pleuritic, without nausea or diaphoresis.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. link] Harhash AA et al.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. There is some ST-segment elevation in DII, DIII, aVF, V4-6.

Tachycardia 111

Tachycardia Blog Ischemia Heart Failure 111

Dr. Smith's ECG Blog

SEPTEMBER 21, 2022

A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. OMI that are not STEMI can be very subtle and difficult to diagnose even though the findings are very specific.

Chest Pain 52

Chest Pain Blog Ischemia STEMI 52

Dr. Smith's ECG Blog

JULY 1, 2019

Case 2: sent by Dr. James Alva A man in his 50s with diabetes, hypertension, and hyperlipidemia presented to the ED with chest pain and shortness of breath off and on over the past three days, with associated vomiting. There is also much STE in V3-V6, especially V4-V6, that must be considered to be STEMI.

Chest Pain 52

Chest Pain Ischemia STEMI Blog 52

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

A middle-aged diabetic dialysis patient presented with 24 hours of nausea and vomiting associated with ~6 pound weight loss. He denied fevers and chills, abdominal pain, chest pain, or SOB. It is uncommon in the age of reperfusion therapy, as most STEMI get treated reasonably early, before transmural infarct.

Aneurysm 52

Aneurysm Ischemia Embolism STEMI 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The patient said his chest pain was 4/10, down from 8/10 on presentation. The documentation does not describe any additional details of the history. ECG 1 What do you think?

Angina 119

Angina Plaque Document Stents 119

Dr. Smith's ECG Blog

JANUARY 28, 2018

A man is his late 50’s presents to the ED with 1 hour of post exertional chest pressure associated with diaphoresis and nausea. He has a history of known CAD, diabetes, and dyslipidemia. Moreover, T-wave inversion in aVL was also found to be 100% sensitive and 86% specific for inferior STEMI. mm ST depression in aVL.

Pericarditis 52

Pericarditis Ischemia STEMI Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. He is an interventionalist in Turkey. A second ECG was taken at 15:16. Wait for the angiogram.

Chest Pain 52

Chest Pain Myocardial Infarction Blog Pericarditis 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left.

Plaque 126

Plaque Angina Blog Stents 126

Dr. Smith's ECG Blog

MARCH 2, 2019

Palpitations in a Young Healthy Male A pathognomonic ECG you should recognize instantly A middle-aged man with severe syncope, diffuse weakness Chest pain and Diffuse ST depression, with STE in aVR. Biphasic T-waves in a Middle-Aged Male with Vomiting Diabetic Ketoacidosis: is there hypokalemia? Are These Wellens' Waves??

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. His history included known heart failure with prior EF 18%, insulin dependent diabetes, and polysubstance abuse. Vitals were within normal limits except for tachypnea.

Chest Pain 120

Chest Pain STEMI Cardiogenic Shock Heart Failure 120

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain.

Chest Pain 119

Chest Pain STEMI Ultrasound Heart Attack 119

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. Theiling BJ.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

DECEMBER 6, 2022

A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. Had the cardiologists followed NSTEMI or transient STEMI guidelines, which recommend non-urgent cath, the patient could have redeveloped an OMI and had a worse outcome.

Chest Pain 52

Chest Pain STEMI Diabetes Circulation 52

Dr. Smith's ECG Blog

OCTOBER 22, 2024

This was sent to me by a French colleague, Olivier Peyronie "Yesterday we received a 62 yo man with diabetes, hypertension and smoker. He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. You must record frequent serial ECGs for patients with chest pain.

Chest Pain 65

Chest Pain STEMI Myocardial Infarction Angioplasty 65

Dr. Smith's ECG Blog

OCTOBER 30, 2024

All of the patients contacted EMS due to acute onset chest pain. The above ECG is from a 70 something male with chest pain. ECG #2 Case 2 : The above ECG was obtained from a diabetic 45 year old smoker with chest pain. All ECGs in this case have saddleback ST elevation. ECG #1 Case 1. ECG #3 Case 3.

Chest Pain 110

Chest Pain Aortic Myocardial Infarction STEMI 110

Dr. Smith's ECG Blog

FEBRUARY 16, 2025

Written by Willy Frick A man in his mid 30s with type 1 diabetes presented with two days of midsternal and epigastric pain, described as both "sharp" and squeezing." He said the pain was worse with supination and improved with upright posture. The patient was treated with aspirin and a GI cocktail, which did not help the pain.

STEMI 71

STEMI Pericarditis Chest Pain Echocardiogram 71

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. 50% of LAD STEMI have Q-waves by one hour. Smith : In limb leads, the ST vector is towards lead II (STE lead II STE lead III, which is more likely with pericarditis than with STEMI). He presented to the emergency department for evaluation.

Chest Pain 88

Chest Pain Pericarditis Myocardial Infarction Dementia 88

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI".

STEMI 120

STEMI Chest Pain Myocardial Infarction Aneurysm 120