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. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. He had this ECG recorded. Are the lungs clear?

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

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 119

Chest Pain Blog Hospital Tachycardia 119

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. Patient 1 remained in the hospital overnight. It was stented.

Chest Pain 115

Chest Pain STEMI Echocardiogram Stents 115

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

FEBRUARY 6, 2024

Chest trauma was suspected on initial exam. The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Hopefully a repeat echocardiogram will be performed outpatient. RBBB in blunt chest trauma seems to be indicative of several RV injury. No cardiac MRI was done.

Tachycardia 114

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 114

Dr. Smith's ECG Blog

APRIL 15, 2020

Here is her ED ECG: Here is the ED physician's interpretation: IMPRESSION UNCERTAIN REGULAR RHYTHM, wide complex tachycardia, likely p-waves. LEFT BUNDLE BRANCH BLOCK [120+ ms QRS DURATION, 80+ ms Q/S IN V1/V2, 85+ ms R IN I/aVL/V5/V6] Comparison Summary: LBBB and tachycardia are new. This is clearly ventricular tachycardia.

Tachycardia 52

Tachycardia Nursing Heart Disease Dysrhythmia 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

Although the patient reported experiencing mild pressure-like chest pain, there was suspicion among clinicians that this might be indicative of an older change. A rapid echocardiogram was performed, revealing an ejection fraction of 20% with thinning of the anterior-apical walls. What is the rhythm? Smith : Are they P-waves?

Tachycardia 111

Tachycardia Blog Ischemia Heart Failure 111

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 Stents Stent 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 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 21, 2019

They were recorded 12 minutes apart: "Hey Steve, 30-something with one week of chest pain, mostly right-sided, better with sitting up.": Get an emergent contrast echocardiogram. This history of a week of constant chest pain is also much more suggestive of myocarditis. What do you think? flat ST segment in V4 2.

Chest Pain 52

Chest Pain Myocardial Infarction Pericarditis Angina 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. Echocardiogram: EF 50%, akinesis of mid-apical anteroseptal, inferior, and inferoseptal myocardium. Submitted by anonymous, written by Pendell Meyers.

STEMI 52

STEMI Chest Pain Stents Stent 52

Dr. Smith's ECG Blog

OCTOBER 25, 2022

She reports that she is now unable to vagal out of her palpitations and is having shortness of breath and dull chest pain. We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. Now the patient is in sinus tachycardia. She had an echocardiogram which was normal.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Ablation 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? A normal PR interval.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 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. Severe Tachycardia Acute Coronary Syndrome (obstructive coronary disease) a. This results in Type I MI.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

The pneumothorax was expanded with a chest tube At 17 hours, another ECG was recorded: It is now much less dramatic and has the morphology of Type 2 Brugada The hs troponin I peaked at 6500 ng/L -- this strongly suggests myocardial contusion. An echocardiogram was done. Sinus Tachycardia ( common in any trauma patient. ).

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

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

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. We can see enough to make out that the rhythm is sinus tachycardia. It was not worse with exertion or relieved by rest.

Chest Pain 63

Chest Pain Blog Arrhythmia Critical Care 63

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 138

Chest Pain Embolism Pulmonary Tachycardia 138

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

Wellnest

DECEMBER 21, 2022

However, an echocardiogram is a different test, also conducted for heart activity. If you experience any symptoms, such as chest pain, dizziness, unusual tiredness or fatigue, shortness of breath, or irregular heartbeat, your doctor would want you to go for an ECG test to find out the underlying cause.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. BP:143/99, Pulse 109, Temp 37.2 °C

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

Otherwise vitals after intubation were only notable for tachycardia. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

Patients who present with chest pain or cardiac arrest and have an ECG diagnostic of STEMI could have myocardial rupture. 5 of 6 presented with chest pain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound. Obviously, administration of heparin and/or lytics is hazardous.

Cardiac Arrest 40

Cardiac Arrest Tachycardia STEMI Chest Pain 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). Most physicians will automatically be worried about these symptoms.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 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.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

JANUARY 21, 2025

He denied chest pain. A Chest X-ray did not show pulmonary edema. This ECG was recorded: It is difficult to appreciate P-waves, but I believe this is sinus tachycardia. It is correct that he did not have chest pain, but we must remember that fully 1/3 of full blown STEMI do not present with chest pain.

Chest Pain 61

Chest Pain STEMI Tachycardia Myocardial Infarction 61

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. Or both?

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Chest Pain Cardiac Arrest Tachycardia ICU 80