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.

Chest Pain 67

Chest Pain Blog Critical Care Arrhythmia 67

Dr. Smith's ECG Blog

JUNE 17, 2018

A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. Inclusion criteria were chest pain, at least 2 serial cTnI in 24 hours, sinus rhythm , and at least 1 ECG.

Chest Pain 52

Chest Pain Pericarditis Tachycardia 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.

Chest Pain 141

Chest Pain Embolism Pulmonary Tachycardia 141

Dr. Smith's ECG Blog

OCTOBER 24, 2019

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." The initial troponin I was elevated at 0.75

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MAY 13, 2017

He complained of severe chest pain and was extremely agitated, so much so that he was throwing chairs in triage. Some time later, reperfusion T-waves developed (analogous to Wellens' waves): Case 3 Here is a case of a 30-something otherwise healthy male with chest pain: There is neither an S-wave nor J-wave in lead V3.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Upon questioning patient, he denies having any chest pain or chest tightness of any sort. In the absence of chest pain and negative troponin , it appears less likely that he is having acute coronary syndrome though EKG appears concerning. Pericarditis would be even more unlikely in someone without chest pain.

Chest Pain 52

Chest Pain Coronary Artery Bypass Graft Pericarditis Blog 52

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. EMS gave 324 mg aspirin and 3 sublingual NTG, which the patient stated reduced the substernal chest pain from an 8/10 to 4/10. Pain better still. What do you think the echocardiogram shows? NTG drip started.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

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 52

Chest Pain STEMI Cardiogenic Shock Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. He later developed mild continuous chest pain, that he describes as the sensation of someone standing on his chest. See this post: What do you think the echocardiogram shows in this case?

Chest Pain 111

Chest Pain Ischemia Echocardiogram Myocardial Infarction 111

Dr. Smith's ECG Blog

DECEMBER 9, 2023

The medics stated he had been nauseated and diaphoretic, but he did not have any chest pain or SOB. And especially suspect Old MI when the patient gives a history of MI and has no chest pain or SOB. Case continued The patient underwent an emergency formal echocardiogram and it was unchanged. Learning Points: 1.

Aneurysm 115

Aneurysm Chest Pain Echocardiogram STEMI 115

Dr. Smith's ECG Blog

NOVEMBER 4, 2018

A middle-aged woman presented with chest pain. She had a normal echocardiogram, with normal shortening and thickening of the septum. She had no history of cardiac disease. She had this presenting ECG: There are Q-waves in V1 and V2 The computer read was "Septal MI, age indeterminate" Is it a septal MI?

Chest Pain 52

Chest Pain Anatomy Echocardiogram Article 52

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? Do NOT use them.

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

Heart BMJ

JUNE 25, 2024

After 24 hours, the patient was readmitted to the hospital with chest pain and troponin elevation, without ECG changes. A transthoracic echocardiogram (TTE) revealed a mobile mass on the right coronary cusp of the aortic valve ( figure 1 , ). The patient was discharged and apixaban was restarted 10 hours later.

Aortic valve 59

Aortic valve Aortic Chest Pain Atrial Fibrillation 59

Dr. Smith's ECG Blog

JUNE 11, 2024

Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. Formal echocardiogram: Systolic function is at the lower limits of normal. Three patients with chest pain and “normal” ECGs: which had OMI? Which were normal?

Chest Pain 116

Chest Pain STEMI Blog Exercise 116

Frontiers in Cardiovascular Medicine

OCTOBER 7, 2024

Our report describes two cases of SVS treated with endocardial ablation to improve LVOTO.Case reportCase 1: A 74-year-old female patient with angina and syncope was admitted to the hospital and diagnosed with SVS by transthoracic echocardiogram. After RFA was performed, the patient's symptoms significantly improved.

Ablation 59

Ablation Angina Chest Pain Echocardiogram 59

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. First troponin I returns at 48 ng/L ECG 5 143 min No significant change ECG 6 261 min Same hs Troponin I profile (peaked at 1849): Formal Echocardiogram SUMMARY The estimated left ventricular ejection fraction is 74 %.

Chest Pain 118

Chest Pain Myocardial Infarction STEMI Critical Care 118

Heart BMJ

AUGUST 14, 2024

He was admitted to our hospital with issues of chest pain, shortness of breath and heart palpitations without any obvious inducement. Figure 1 Transthoracic echocardiogram. (A) A 12-lead ECG indicated sinus rhythm with a heart rate of 78 bpm. A) Parasternal long-axis view of the.

Aneurysm 52

Aneurysm Chest Pain Myocardial Infarction Thrombosis 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

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. Her contrast enhanced echocardiogram is shown below in the parasternal short axis view. At midnight.

Myocardial Infarction 127

Myocardial Infarction Chest Pain STEMI Blood Pressure 127

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. The prehospital ECG of Patient #1 — showed an obvious acute STEMI.

Chest Pain 114

Chest Pain STEMI Echocardiogram Stents 114

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

The echocardiogram showed normal cardiac structure and function, however, there was a concern for possible anomalous origin of the left coronary artery. Treadmill exercise stress test showed excellent functional capacity without exercise-induced chest pain or ischemic ECG changes.

Chest Pain 59

Chest Pain Exercise Electrocardiogram Echocardiogram 59

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast. The patient was given opiates which improved his chest pain to 7/10. The consulting cardiologist wrote in their note: “Could be cardiac chest pain. She is usually incredibly good at recognizing them!

Chest Pain 116

Chest Pain Blog Hospital Tachycardia 116

HeartRhythm

SEPTEMBER 8, 2024

An echocardiogram showed newly reduced left ventricular ejection fraction of 30-35%. 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.

Defibrillator 40

Defibrillator Pacemaker Chest Pain Coronary Artery Disease 40

Open Heart

APRIL 20, 2022

Twenty-one (41%) had normal echocardiogram, 13 (25%) a hypokinetic non-dilated cardiomyopathy (HNDC) and 17 (33%) a dilated cardiomyopathy (DCM). Clinical contexts leading to diagnosis were SCD in 3 (6%), ventricular arrhythmias in 15 (29%), chest pain in 8 (15%), heart failure in 6 (12%) and familial screening in 20 (38%).

Cardiomyopathy 52

Cardiomyopathy Chest Pain Sudden Cardiac Death Heart Failure 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

Dr. Smith's ECG Blog

DECEMBER 5, 2016

This ECG could easily be seen in an ED chest pain patient, and I have seen many) What do you think? Comment I (Smith) have seen many similar ECGs in ED chest pain patients. I have seen this innumerable times in chest pain patients in the Emergency Department. Description Sinus bradycardia.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Bradycardia 52

Dr. Smith's ECG Blog

JULY 14, 2023

Formal Echocardiogram: Normal left ventricular size and wall thickness. had an initial hs-cTnI less than 52 ng/L (a level with a high PPV for Type 1 MI -- OMI or NOMI) Trops peaked at greater than 36,000 ng/L (very large MI of course) Post PCI ECG the next day: Looks like a nearly completed anterior MI, in spite of rapid reperfusion.

Cardiac Arrest 92

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 92

Dr. Smith's ECG Blog

OCTOBER 22, 2024

He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. The echocardiogram shows a preserved left ventricular ejection fraction (LVEF) of 55% with marked basal and mid inferolateral and basal anterolateral hypokinesia. The first ECG (10h14) showed TWI in inferior leads."

Chest Pain 70

Chest Pain STEMI Myocardial Infarction Angioplasty 70

Dr. Smith's ECG Blog

MARCH 9, 2013

This male in his 40's had been having intermittent chest pain for one week. He awoke from sleep with crushing central chest pain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric. The peak troponin I was 0.364 ng/ml.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Ischemia Angina 52

Circulation

NOVEMBER 11, 2024

Case presentation:A 64-year-old man presented with one day of chest pain. Transthoracic echocardiogram (TTE) showed an ejection fraction (EF) of 40% and a moderate-large pericardial effusion with signs of tamponade. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024.

Myocardial Infarction 40

Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain 40

Dr. Smith's ECG Blog

APRIL 12, 2013

He had no chest pain. The computer read is: **Acute MI ** The protocol for prehospital activation in the EMS system that this patient presented to requires 2 elements: 1) Chest pain 2) A computer read of **Acute MI ** Only 1 of 2 was present, so there was no prehospital activation. The patient was transported to the ED.

STEMI 52

STEMI Pulmonary Stent Stents 52

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. Formal echocardiogram showed normal EF, no wall motion abnormalities, no pericardial effusion.

Chest Pain 74

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 74

Dr. Smith's ECG Blog

OCTOBER 30, 2023

A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. He had no h/o heart failure. Regional wall motion abnormality-inferior. Regional wall motion abnormality-inferolateral. This means posterior in common terminology) --Normal LV cavity size with moderately increased thickness.

STEMI 121

STEMI Heart Failure Stents Stent 121

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms.

Pericarditis 52

Pericarditis Chest Pain Aortic Blog 52

Wellnest

DECEMBER 31, 2023

Yes, COVID-19 symptoms can resemble a heart attack, including chest pain, shortness of breath, and changes in echocardiogram or EKG. Myocarditis symptoms can also mimic a heart attack, and small blood clots may cause pain. Can COVID-19 symptoms mimic a heart attack?

COVID-19 52

COVID-19 Heart Attack Heart attacks Exercise 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chest pain. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded. Troponins peaked at 0.275 ng/ml.

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean.

Stroke 74

Stroke Strokes Chest Pain Cardiomyopathy 74