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 120

Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. The red arrow shows a roughly 80% stenosis of the proximal LAD. An echocardiogram showed an EF of 20-25%.

Outcomes 113

Outcomes Stenosis Outpatient Echocardiogram 113

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. The first hs troponin I returned at 1100 ng/L Angiogram Lesion on 1st Obtuse Marginal : Proximal subsection = 90% stenosis Stented. He had no h/o heart failure. Pre procedure TIMI III flow was noted.

STEMI 123

STEMI Heart Failure Stents Stent 123

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. de Zwaan C.,

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia Angina 52

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

Dr. Smith's ECG Blog

JUNE 18, 2011

3 hours prior to calling 911 he developed typical chest pain. The patient had a critical LAD stenosis. When flow is restored, wall motion may completely recover so that echocardiogram does not detect the previous ischemia. Pain was typical for MI (substernal, not postional or sharp, resolved with NTG) b.

STEMI 52

STEMI Pericarditis Hospital Aneurysm 52

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

Dr. Smith's ECG Blog

JULY 16, 2022

This middle aged male with h/o GERD but also h/o stents presented to the ED with chest pain. The initial troponin I returned at 1500 ng/L and another ECG was recorded as the patient complained of 9/10 chest pain at 10 hours after the first Now the T-wave in III is fully upright, suggesting re-occlusion.

Chest Pain 52

Chest Pain Bradycardia Blog Critical Care 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).

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

JANUARY 28, 2023

Case 1 A middle aged woman presented with acute chest pain and shortness of breath, unclear time since onset, and likely with episodic symptoms off and on throughout the day. Another lesion in the proximal LAD with 80% stenosis was stented as well. Normal RV, no valve stenosis or regurgitation. Additional case by Smith.

STEMI 52

STEMI Chest Pain Stents Stent 52

EMS 12-Lead

JULY 24, 2023

But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chest pain was a little more intense, and the needed recovery period was longer in duration. Aortic Stenosis f. Left Main stenosis (not thrombosed) c. Left Main stenosis (not thrombosed) c.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex.

Plaque 66

Plaque Stents Stent Chest Pain 66

BoardVitals - Cardiovascular

MAY 1, 2017

He has never had any chest pain. Echocardiogram is indicated (Correct) C. Start aspirin and Plavix Correct answer: (B) (B) Echocardiogram is indicated. On the other hand, the murmur in valvular aortic stenosis does not change substantially or decreases slightly following the Valsalva maneuver.

Cardiomyopathy 52

Cardiomyopathy Sudden Cardiac Death Bicuspid/Mitral Electrocardiogram 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? Anything more on history? Left main?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 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. His echocardiogram showed normal wall motion.

Plaque 127

Plaque Angina Blog Stents 127

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. 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). orthostatic vitals b.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

DECEMBER 10, 2024

Written by Pendell Meyers An elderly female called EMS with acute chest pain. She underwent angiogram within a few hours and was found to have mid-RCA culprit lesion, 99% stenosis, TIMI 3 flow. Her vitals were within normal limits, and here is her EMS ECG: What do you think? Initial troponin (high sensitivity trop I): 212 ng/L.

Chest Pain 108

Chest Pain Ischemia Echocardiogram Stents 108

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.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. Smith's ECG Blog

DECEMBER 6, 2024

A 50-something man presented with worsening severe exertional chest pain which was just resolving as he had an ECG recorded in triage. Case continued Troponins over 26 hours, from right to left : Echocardiogram: Mild concentric left ventricular wall thickening, normal cavity size, and normal systolic function. Hard to tell.

Coronary Artery Bypass Graft 107

Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis 107

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.

STEMI 81

STEMI Chest Pain Echocardiogram Stents 81