Dr. Smith's ECG Blog

OCTOBER 18, 2023

Written by Jesse McLaren Four patients presented with chest pain. The above said — the unfortunate reality ( as documented in Dr. McLaren's excellent discussion ) — is that subtle OMIs that can ( and should ! )

Chest Pain 119

Chest Pain STEMI Electrocardiogram Ischemia 119

Dr. Smith's ECG Blog

DECEMBER 29, 2023

Written by Jesse McLaren A previously healthy 50 year-old presented with 24 hours of intermittent exertional chest pain, radiating to the arms and associated with shortness of breath. In a previously healthy patient with new and ongoing chest pain, this is concerning for acute occlusion of the first diagonal artery.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 70

Frontiers in Cardiovascular Medicine

OCTOBER 8, 2024

ObjectiveAlthough the association between admission glucose (AG) and major adverse cardiac events (MACE) is well-documented, its relationship with 30-day MACE in patients presenting with cardiac chest pain remains unclarified.

Chest Pain 52

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction 52

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

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Chest Pain Embolism Pulmonary Tachycardia 138

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

52-year-old lady presents to the Emergency Department with 2 hours of chest pain, palpitations & SOB. Without them the diagnosis is often tough and one must often rely on other clinical data- serial ECG’s, troponin, on-going chest pain, etc. This was written by Sam Ghali ( @ EM_RESUS ), with a few edits by me.

Chest Pain 52

Chest Pain Aneurysm STEMI Document 52

Dr. Smith's ECG Blog

APRIL 4, 2023

Submitted by Dr. Dennis Cho (@DennisCho), written by Jesse McLaren A 70-year-old with no cardiac history presented with 2 hours of chest pain radiating to the neck, associated with shortness of breath. As he documented, “This patient is experiencing chest pain consistent with an acute coronary syndrome.

Chest Pain 52

Chest Pain STEMI Ischemia Document 52

Dr. Smith's ECG Blog

APRIL 14, 2023

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin.

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Chest Pain STEMI Stents Stent 52

Dr. Smith's ECG Blog

MAY 16, 2023

Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chest pain". Anxiety is a common cause of chest pain with tachycardia.

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Chest Pain Pericarditis Tachycardia STEMI 52

Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). The patient was still with ongoing chest pain at the time ECG #1 was done.

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Chest Pain STEMI Aneurysm Pericarditis 52

Dr. Smith's ECG Blog

JUNE 14, 2017

There was apparently no syncope and he had no bony injuries, but he did complain of left sided chest pain. His chest was tender. A bedside cardiac ultrasound was normal. An ECG was recorded: Avinash was understandably confused by this ECG. He wrote: "ECG 1 - shows wide ???IVCD IVCD type rhythm ??

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Chest Pain Congenital Heart Disease Article Congenital 52

Dr. Smith's ECG Blog

JUNE 30, 2023

These were texted to me only with "chest pain." It helps to know that the patient has active chest pain, as Wellen's is a post occlusion (reperfusion) state, with open artery and pain-free. Smith and Meyers containing thousands of tracings with documentation of cardiac catheterization results. It was indeed.

Chest Pain 52

Chest Pain Blog Ischemia Document 52

Dr. Smith's ECG Blog

MARCH 31, 2023

It is from a 50-something with chest pain: What do you think? Up until recently — all computerized ECG interpretation programs that I am aware of used standard millimeter-based STEMI critieria as the basis for determining which chest pain patients should "qualify" for prompt cath with PCI. This was sent to me by a friend.

Chest Pain 52

Chest Pain STEMI Blog Academic 52

Dr. Smith's ECG Blog

MARCH 7, 2024

. = I had a previous case of an adolescent with trauma and chest pain who also had AIVR: An adolescent with trauma, chest pain, and a wide complex rhythm From this blog post: "AIVR is NOT common in otherwise healthy children.

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Hemorrhage Chest Pain AFIB Article 125

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Submitted by Benjamin Garbus, MD with edits by Bracey, Meyers, and Smith A man in his early 30s presented to the ED with chest pain described as an “explosion" of left chest pressure. Today’s pain lasted around 20 mins, but was severe enough that the patient called EMS. Triage EKG: What do you think?

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.

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Chest Pain Myocardial Infarction Blog Stents 130

Dr. Smith's ECG Blog

MARCH 27, 2025

After only 90 minutes of chest pain, the first troponin was unsurprisingly in the normal range at 11ng/L (normal <26 in males and <16 in females), so the emergency physician waited for repeat troponin. Chest pain still persists. Paged cardiology 0800: patient complains of chest pain. Cardiology aware.

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STEMI Chest Pain Pericarditis Ischemia 80

Circulation

NOVEMBER 11, 2024

Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. Length of stay (LOS) in the CPU to discharge was 10.4

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Chest Pain ACE Inhibitor Cardiac Function Coronary Artery Disease 40

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Triage documented a complaint of left shoulder pain. See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. This is different from nitroglycerin which produces vasodilation and can improve by pain improving myocardial perfusion. See this case: A man his 50s with chest pain.

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Myocardial Infarction Chest Pain STEMI Blood Pressure 123

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.

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Chest Pain STEMI Ultrasound Heart Attack 120

Frontiers in Cardiovascular Medicine

OCTOBER 7, 2024

Case 2: A 57-year-old female was admitted to the hospital due to recurrent chest pain after physical activity for more than four years. Additionally, septum decreased from 16 to 13 mm after ten months, and the morphological changes associated with SVS also disappeared.

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Ablation Angina Chest Pain Echocardiogram 59

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling. The history is concerning ( This patient was awakened from sleep by chest pain that persisted for several hours — on a background of intermittent CP in recent weeks ).

Ischemia 121

Ischemia Plaque Stenosis Myocardial Infarction 121

DAIC

MARCH 7, 2024

The purpose of the document was to consolidate multiple terms and provide clear definitions for terms applicable to cardiac CT. The document underwent organizational review by the SCCT Board of Directors and the AAPM board, as well as the ACR, NASCI and RSNA’s boards, in addition to peer reviewers. Clinical applications.

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Technology Document Cardiovascular Imaging Cancer 111

Dr. Smith's ECG Blog

JULY 22, 2023

He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon.

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

Dr. Smith's ECG Blog

JULY 3, 2018

Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. The pain initially started the day prior to presentation. The ST elevation from today is ~0.2

Pericarditis 52

Pericarditis Chest Pain Stents Stent 52

Circulation

NOVEMBER 11, 2024

Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chest pain for 2 months. EKG, cardiac enzymes, and Initial echocardiogram(TTE) was unremarkable.

Chest Pain 40

Chest Pain Echocardiogram Document Ischemia 40

Open Heart

AUGUST 4, 2023

The most frequently documented symptoms were dyspnoea (64%), oedema (62%) and palpitations (57%). We identified six symptom clusters: generally symptomatic, dyspnoea and oedema, chest pain, anxiety, fatigue and palpitations, and asymptomatic (reference). female, 58% white).

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Atrial Fibrillation Ablation Chest Pain Document 52

Dr. Smith's ECG Blog

MARCH 4, 2024

Algorithm: Veritas (on Mortara machines) The Queen gets it right Case 2 A middle-aged woman with chest pain and a "normal" ECG in triage. Algorithm is either Glasgow or Marquette 12 SL The Queen gets it right Case 7 Chest pain relieved by Maalox and viscous lidocaine. The OMI was not seen and she arrested in triage.

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STEMI Blog Chest Pain Webinar 127

Dr. Smith's ECG Blog

DECEMBER 14, 2018

(In other words, the artery was occluded but has sponteneously reperfused, resulting in pain relief) It is important to monitor patients with Wellens' syndrome for re-occlusion, which is usually, but not always, associated with recurrent chest pain. The patient remained pain free. Chest Pain scores can be misleading.

Chest Pain 52

Chest Pain Angina Ischemia Stenosis 52

The British Journal of Cardiology

JUNE 11, 2024

Manifestations of CVDs, such as chest pain, abnormal serum markers, unstable angina, myocardial infarction (MI), myocarditis, and new-onset hypertension, were documented. The most common symptom was left hemithorax and interscapular pain (317 patients, 46%).

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COVID-19 Cardiovascular Disease Angina Chest Pain 40

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours.

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

Here is the clinical story: A 40 year old male with no cardiac history presented with acute substernal chest pain that started 40 minutes prior to arrival. In spite of a relatively short QTc of 376 ms, the very low R-wave amplitude in V4 and the ST Elevation at 60 ms after the J-point in lead V3 contribute to a high final value.

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STEMI Stenosis Plaque Chest Pain 130

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 documentation does not describe any additional details of the history. They also documented "Reproducible chest tenderness." The following ECG was obtained.

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Angina Plaque Document Stents 120

Dr. Smith's ECG Blog

MARCH 8, 2021

He was a 30-something with chest pain. A male in his 30's complained of sudden severe substernal chest pain. This is the longest lasting I have ever documented a hyperacute T wave without going "up" or "down." Shoulder pain after lifting a heavy box de Winter's -- they remained stable for 30 minutes with many ECGs.

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Chest Pain STEMI Ischemia Critical Care 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!) Potassium resulted as 4.9,

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STEMI Document Blog Ischemia 115

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. Jernberg T, et al.

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Chest Pain Thrombosis Myocardial Infarction STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. A 50-something presented with s udden onset palpitations 8 hrs prior while sitting at desk at work.

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Tachycardia Cardiogenic Shock Angina Coronary Angiogram 138

Dr. Smith's ECG Blog

JUNE 4, 2019

A 40-something woman presented to the ED having had “heartburn” overnight and then worsening chest pain 1 hour prior to arrival. T his is a systematic failure that has been documented in the following study: Garg A, Lehmann MH. In a patient with new-onset chest pain — this is diagnostic of acute OMI until you prove otherwise.

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Chest Pain STEMI Ischemia Aortic 52