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.

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STEMI Pulmonary Stents Stent 52

Dr. Smith's ECG Blog

JUNE 18, 2013

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. On echocardiogram, there was a 40% ejection fraction with anterior wall motion abnormality. This patient had continued and ongoing pain. His ECG was repeated at this point: This shows a well developed anterior STEMI.

STEMI 52

STEMI Chest Pain Myocardial Infarction Webinar 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Hopefully a repeat echocardiogram will be performed outpatient. ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. 1900: RBBB and LAFB are almost fully resolved.

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 114

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. Gottlieb SO, et al.

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Chest Pain Thrombosis Myocardial Infarction STEMI 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. It is also NOT the clinical scenario of takotsubo (a week of intermittent chest pain).

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Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

JULY 31, 2018

These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. The 1st “lesson” is, “All bets are off” — when an adult of any age presents to the ED with new-onset chest discomfort. Regional wall motion abnormality-distal inferior wall.

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SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

A 40 something otherwise healthy man presented with substernal chest pain. Formal Echocardiogram: The estimated left ventricular ejection fraction is 58 %. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. What do you think? This ECG is DIAGNOSTIC of acute LAD Occlusion.

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Chest Pain STEMI Article Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. See this case: what do you think the echocardiogram shows in this case?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JUNE 23, 2024

Echocardiogram showed LVEF 66% with normal wall motion and normal diastolic function. He did not remember whether he had experienced any chest pain. Two subsequent troponins were down trending. Within a few days, the patient was extubated and was neurologically intact.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 117

Dr. Smith's ECG Blog

MAY 13, 2017

Case 1: The outcome of this case is at the far bottom. He complained of severe chest pain and was extremely agitated, so much so that he was throwing chairs in triage. In any case, the patient needs at a minimum serial ECGs and perhaps a formal echocardiogram. His chest pain resolved.

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Chest Pain STEMI Cardiac Arrest Myocardial Infarction 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.

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Myocardial Infarction Chest Pain STEMI Blood Pressure 122

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.

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Chest Pain Ultrasound STEMI Myocardial Infarction 52

DAIC

APRIL 8, 2024

All patients had an ejection fraction of 50% or higher as assessed with an echocardiogram performed within one week of their heart attack. While this unblinded approach could potentially introduce bias, researchers said that this was not likely to have an effect on outcomes such as death and heart attacks.

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Heart Attack Heart attacks Heart Failure Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 7, 2013

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. Although the patient has had pain for 4 days, could the artery have fully occluded only within hours? There was some SOB. Very unlikely. Raitt et al.) [and

STEMI 52

STEMI Myocardial Infarction Pericarditis Ultrasound 52

Dr. Smith's ECG Blog

JULY 18, 2014

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. such Q-waves are associated with larger MI and worse outcomes (2. There was some SOB. He had walked into the ED (did not use EMS). Obviously there is MI.

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

APRIL 3, 2019

History : An extremely elderly patient who lived independently presented with acute "oppressive" chest pain 7/10 in severity that was not positional, pleuritic, or reproducible. Because of occasional catastrophic outcomes in patients with transient STEMI, I recommend that it be managed just like a persistent STEMI.

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STEMI Chest Pain Ischemia Aneurysm 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). These premonitory symptoms were negative predictors of adverse outcomes in EGSYS.

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Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. She awoke in the morning with sharp chest pain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.

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Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

MARCH 17, 2025

Written by Willy Frick A man in his 60s with a history of hypertension and 40 pack-year history presented to the ER with 1 day of intermittent, burning substernal chest pain radiating into both arms as well as his back and jaw. Echocardiogram showed inferior hypokinesis. Troponin was rising when last checked, 8928 ng/L.

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STEMI Chest Pain Myocardial Infarction Document 80

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

Written by Pendell Meyers, few edits by Smith A woman in her 70s was woken from sleep by midsternal chest pain radiating to left arm with nausea. Echocardiogram: EF 42% Moderate hypokinesis of the mid anterolateral and apical lateral myocardium Final diagnosis by the cardiologist was "STEMI" despite never meeting STEMI criteria.

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STEMI Chest Pain Echocardiogram Stents 80

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Long term outcome is not available. == MY Comment, by K EN G RAUER, MD ( 2/1/2025 ): == We need to learn from cases like today's. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH. 4 days later: Continued reperfusion.

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Cardiac Arrest STEMI Blog Ischemia 85

Dr. Smith's ECG Blog

APRIL 18, 2025

He played a round of golf a week prior and felt an episode of chest pain during the round, which spontaneously resolved. On presentation, he reported no chest pain or shortness of breath. Five days later, the patient was exercising when he developed chest pain at 19:30 which lasted for an hour.

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Chest Pain Cardiac Arrest Tachycardia ICU 80