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 74

Dr. Smith's ECG Blog

MAY 23, 2023

Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset. Am J Emerg Med. 2022 Jan;51:384-387.

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Chest Pain STEMI Blog Stents 86

Dr. Smith's ECG Blog

MARCH 17, 2023

Submitted by anonymous, written by Pendell Meyers A woman in her 50s presented to the Emergency Department with chest pain and shortness of breath that woke her from sleep, with diaphoresis. See these other cases of arterial pulse tapping artifact: A 60 year old with chest pain Are these Hyperacute T-waves?

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Chest Pain Coronary Angiogram Circulation Electrocardiogram 52

Dr. Smith's ECG Blog

JUNE 17, 2023

Written by Pendell Meyers A middle aged man called EMS for acute chest pain. Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms. EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. I said "Not OMI.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

NOVEMBER 10, 2017

This was sent to me by a former resident from a community hospital: A middle-aged woman complained of chest pain and was seen in triage. Comment This paper has received some press recently: Safety of Computer Interpretation of Normal Triage Electrocardiograms The algorithm used was also the GE Marquette 12 SL. Normal ECG."

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Chest Pain Bradycardia Technology Electrocardiogram 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.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. DIagnostic accuracy oF electrocardiogram for acute coronary OCClusion resulTing in myocardial infarction (DIFOCCULT study). Who needs the cath lab? Int J Cardiol Heart Vasc 2021 2. Aslanger et al.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. A 12-lead electrocardiogram, lead V4R , and leads V7-9 were recorded on admission. His prehospital ECG was diagnostic of inferior posterior OMI. The patient was in clinical shock with a lactate of 8. He appeared gray in color, with cool skin.

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Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 78

Dr. Smith's ECG Blog

AUGUST 3, 2017

A 70-year-old man calls 911 after experiencing sudden, severe chest pain. Common pitfalls in the interpretation of electrocardiograms from patients with acute coronary syndromes with narrow QRS: a consensus report. This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! This is his 12-Lead ECG: What do you think?​

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Chest Pain Myocardial Infarction STEMI Ischemia 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.

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Chest Pain STEMI Blog Academic 52

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion. This is a huge anterolateral OMI. I cannot be anything else.

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Chest Pain Myocardial Infarction STEMI Pacemaker 52

Open Heart

AUGUST 25, 2024

Background Patients with low HEART (History, Electrocardiogram, Age, Risk factors, and Troponin level) risk scores who are discharged from the emergency department (ED) may present clinical challenges and diagnostic dilemmas. The use of downstream non-invasive stress imaging (NISI) tests in this population remains uncertain.

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Chest Pain Coronary Artery Disease Myocardial Infarction Electrocardiogram 52

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.

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Chest Pain ACE Inhibitor Cardiac Function Coronary Artery Disease 40

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. Three patients with chest pain and “normal” ECGs: which had OMI? Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

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Chest Pain STEMI Blog Exercise 112

DAIC

DECEMBER 13, 2023

The findings, described in the journal npj Digital Medicine on December 12, 2023, used data on nearly half a million people who had each worn an electrocardiogram (ECG) patch to record their heart rhythms for two weeks—a routine screening test for AFib and other heart conditions.

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Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Electrocardiogram in clinic showed sinus arrhythmia with early repolarization and no ischemic changes. Treadmill exercise stress test showed excellent functional capacity without exercise-induced chest pain or ischemic ECG changes. Invasive coronary angiography ruled out luminal narrowing or dynamic compression.

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Chest Pain Exercise Electrocardiogram Echocardiogram 59

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Echo showed new anterior regional wall motion abnormality and decrease EF from 60% to 45%. Clin Cardiol 2022 4.

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STEMI Chest Pain Myocardial Infarction Stent 119

Dr. Smith's ECG Blog

MARCH 10, 2017

A 61 year-old with chest pain arrived to the ED by ambulance with resolving chest pain. Safety of Computer Interpretation of Normal Triage Electrocardiograms. The chest pain is resolving, so if these are resolving hyperacute T-waves, then followup ECGs should show their size diminishing.

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STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

HeartRhythm

SEPTEMBER 17, 2024

The clinical examination did not reveal any abnormalities, however, the 12-lead electrocardiogram showed abnormal biphasic T-waves, particularly pronounced in the right and anterior precordial leads (Figure 1). The patient didn't experience any chest pain over the previous few days.

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Chest Pain Certification Electrocardiogram 40

Dr. Smith's ECG Blog

DECEMBER 22, 2023

The patient with no prior cardiac history presented in the middle of the night with acute chest pain, and had this ECG recorded during active pain: I did not see any ischemia on this electrocardiogram. This is a case I had quite a while back. See the explainability : She sees large T-waves in V2, V3.

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Chest Pain Bradycardia Blog Electrocardiogram 103

DAIC

APRIL 1, 2024

Most cases go undiagnosed until the condition advances enough to create symptoms such as shortness of breath, chest pain or fatigue. Valvular heart disease, a condition in which any of the heart’s four valves are damaged or diseased, afflicts 2.5 percent of all Americans and 13 percent of Americans over age 80.

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Technology Heart Disease Innovation Ultrasound 105

The British Journal of Cardiology

JUNE 11, 2024

Cardiovascular consultation had been requested for all of the patients based on their primary clinical examination, vital signs, and electrocardiogram (ECG). Manifestations of CVDs, such as chest pain, abnormal serum markers, unstable angina, myocardial infarction (MI), myocarditis, and new-onset hypertension, were documented.

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COVID-19 Cardiovascular Disease Angina Chest Pain 40

Circulation

NOVEMBER 11, 2024

Plane QRS-T angle (PQRS-Ta) can be used as a supplement to the current diagnostic criteria of ECG.Methods:The patients with recurrent chest pain in our hospital were analyzed retrospectively, and the plane QRS-T angle of the patients was calculated. 2) all patients were divided into three groups according to the final diagnosis.

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Electrocardiogram Chest Pain Circulation Hospital 40

Dr. Smith's ECG Blog

OCTOBER 9, 2018

The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardial infarction. We record ECGs in triage on every patient with chest pain, and some other indications, and this amounts to 8000 ECGs in triage each year, costing at most $200,000 (8000 x $20.00). This paper was just published: Noll S.

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Chest Pain STEMI Cardiac Arrest Blog 52

Coronary Artery Disease Journal

JUNE 13, 2024

Electrocardiogram (ECG) might not always show abnormalities, and chest pain is not always present. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region.

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Myocardial Infarction Chest Pain Coronary Artery Disease Electrocardiogram 40

BoardVitals - Cardiovascular

FEBRUARY 10, 2020

Cardiology Board Review Question A 48-year-old female with no known medical history presents with acute substernal chest pain. D) An electrocardiogram is most commonly normal in these patients. Patients typically present with acute chest pain, shortness of breath, or syncope. What is Takotsubo Cardiomyopathy?

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Wellnest

DECEMBER 21, 2022

An electrocardiogram is a machine used to record the heart's electrical 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.

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Cardiac Arrest Heart attacks Heart Attack Atrial Fibrillation 52

Dr. Smith's ECG Blog

JUNE 12, 2017

This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chest pain. link] Here is the history: A 30 yo man presented complaining of severe chest pain.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 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. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. PM Cardio digitized version.

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 67

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.

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STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.

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STEMI Myocardial Infarction Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

MARCH 3, 2023

can cause ST-segment elevation (STE) on electrocardiogram (ECG), the distinction between them may be hard and complicated. We are happy to announce that our "OMI Toolbox" application has just released and ready for your use. As myocardial infarction (MI) and many other diagnoses (for example left ventricular hypertrophy, prior MI etc.)

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Chest Pain STEMI Download Blog 52

Circulation

NOVEMBER 11, 2024

Case presentation:A 64-year-old man presented with one day of chest pain. Electrocardiogram (EKG) was unremarkable. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024. Initial evaluation showed elevated cardiac enzymes (CE) and normal eosinophil count.

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Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain 40

Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 8, 2024

BACKGROUND:The HEART Pathway (History, Electrocardiogram, Age, Risk factors, Troponin) can be used with high-sensitivity cardiac troponin to risk stratify emergency department patients with possible acute coronary syndrome. These findings support the use of a modified hs-HP to improve chest pain care.

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Myocardial Infarction Chest Pain Electrocardiogram Risk Factors 40

MIBHS

MAY 15, 2024

Men typically experience classic symptoms like chest pain or pressure, radiating down the left arm. Traditional diagnostic tests like electrocardiograms (ECG) and stress tests may not always detect heart issues in women due to variations in their symptoms and heart physiology. However, women may not exhibit these telltale signs.

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Heart Disease Chest Pain Risk Factors Blood Pressure 52

MIBHS

FEBRUARY 29, 2024

If a heart murmur does cause symptoms , they may include: Heart palpitations Shortness of breath Dizzy spells An ongoing cough Chest pain or tightness Diagnosing Heart Murmurs You can’t hear a heart murmur without a stethoscope. It may be the result of anemia, an overactive thyroid, high blood pressure, and other common conditions.

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Heart Valves Chest Pain Blood Pressure Electrocardiogram 52

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. Patel DJ, et al.

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Chest Pain Thrombosis Myocardial Infarction STEMI 52