Chest Pain, Electrocardiogram and Ischemia

Which patient has the more severe chest pain?

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

2 middle aged males presented with chest pain. Which had the more severe chest pain at the time of the ECG? Patient 2 at the bottom with a very subtle OMI complained of 10/10 chest pain at the time the ECG was recorded. 414 patients were included in the analysis.

Chest Pain

Chest Pain STEMI Myocardial Infarction Hospital

Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Dr. Smith's ECG Blog

MAY 27, 2024

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? Curr Cardiol Red 2021 3. Kontos et al.

Chest Pain

Chest Pain STEMI Myocardial Infarction Ischemia

Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Written by Jesse McLaren Four patients presented with chest pain. 4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6] Hughes KE , Lewis SM , Katz L , Jones J. Acad Emerg Med.

Chest Pain

Chest Pain STEMI Electrocardiogram Ischemia

A man in his 70s with acute chest pain and paced rhythm.

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. EKG shown here: LAFB with no clear signs of OMI or ischemia. Triage ECG: What do you think? This is a huge anterolateral OMI.

Chest Pain

Chest Pain Myocardial Infarction STEMI Pacemaker

Right precordial ST depression in a patient with chest pain

Dr. Smith's ECG Blog

AUGUST 3, 2017

A 70-year-old man calls 911 after experiencing sudden, severe chest pain. Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. Neth Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Is OMI an ECG Diagnosis?

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. But no ECG met STEMI criteria so the patient was referred to cardiology as Non-STEMI. Clin Cardiol 2022 4.

STEMI

STEMI Chest Pain Myocardial Infarction Stents

Is there OMI on this ECG?

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.

Chest Pain

Chest Pain Bradycardia Blog Electrocardiogram

Why is ECG machine use? What diseases can EKG monitor detect?

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.

Cardiac Arrest

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

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. His response: “subendocardial ischemia. Anything more on history? J Electrocardiol 2013;46:240-8 2.

Ischemia

Ischemia STEMI Stenosis Coronary Artery Disease

Physical Examination as a Helpful Aid in Decision-Making in Challenging ECGs

Dr. Smith's ECG Blog

JANUARY 1, 2024

An initial electrocardiogram (ECG) is provided below. Although the patient reported experiencing mild pressure-like chest pain, there was suspicion among clinicians that this might be indicative of an older change. The patient rapidly regained consciousness, reporting no residual pain. What do you think?

Tachycardia

Tachycardia Heart Failure Ischemia Blog

Hypertrophic Cardiomyopathy

EMS 12-Lead

MAY 20, 2022

There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This is the initial ECG: The QRS is widened with a regular cadence, and there are no discernable P waves.

Cardiomyopathy

Cardiomyopathy Ischemia STEMI Coronary Angiogram

Syncope and Prehospital Cath Lab activation -- What do you think?

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

male with a history of HTN and ETOH developed squeezing epigastric abdominal pain with associated vomiting and diaphoresis, followed by a syncopal episode which lasted about 10 seconds. When medics arrived, he denied any chest pain, shortness of breath, or palpitations prior to the syncopal episode.

Chest Pain

Chest Pain Ischemia Angina Electrocardiogram

Profound ST Elevation in V1-V3. What do you think?

Dr. Smith's ECG Blog

DECEMBER 27, 2018

A Deep Neural Network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation. But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. I do research on Cardiologs' algorithm: Smith SW et al. What an honor.

Chest Pain

Chest Pain Hypertension STEMI Heart Disease

A man in his 70s with weakness and syncope

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.

Chest Pain

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath. Back to the case: The providers recognized persistent ischemia and likely occlusion, and discussed this with cardiology who took the patient immediately for cath. They opened it.

STEMI

STEMI Chest Pain Myocardial Infarction Ischemia

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. hours when she called 911. 0 0 1 41 238 MMRF 1 1 278 14.0

Myocardial Infarction

Myocardial Infarction Pericarditis Angina STEMI

An ECG with only «marginal» change

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The patient contacted EMS after a few hours of chest pain that started 5:30 AM. The pain was described as 6/10 radiating to the right shoulder. The chest pain was described as both sharp and pressure like. Below is the post -PCI electrocardiogram. He is otherwise healthy.

Chest Pain

Chest Pain Blog Risk Factors Ischemia

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He was asked multiple times about chest pain or dyspnea, but repeatedly denied any such symptoms. Patient denied chest pain on initial review of symptoms. Was now endorsing chest pain which began 30 minutes ago. Upon further questioning, he states that he has had intermittent chest pain since yesterday.

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

How does Acute Total Left Main Coronary occlusion present on the ECG?

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.

Myocardial Infarction

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

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.

STEMI

STEMI Myocardial Infarction Chest Pain Angioplasty

Are these Hyperacute T-waves?

Dr. Smith's ECG Blog

DECEMBER 5, 2022

Acute chest pain and a bizarre ECG Bizarre (Hyperacute??) Electromechanical association: a subtle electrocardiogram artifact. I thought the overall picture in these 6 chest leads did not look like acute OMI. It may be that it is much more common than we think but just not recognized. What do you think? 2012;45(1):15-17.

Article

Article Circulation Chest Pain Electrocardiogram

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

It was from a patient with chest pain: Note the obvious Brugada pattern. Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. The elevated troponin was attributed to either type 2 MI or to non-MI acute myocardial injury. There is no further workup at this time. This patient ruled out for MI.

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

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). Evidence of acute ischemia (may be subtle) vii. Abnormal ECG – looks for cardiac syncope.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

Cardiovascular Update

Which patient has the more severe chest pain?

Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

A man in his 70s with acute chest pain and paced rhythm.

Right precordial ST depression in a patient with chest pain

Is OMI an ECG Diagnosis?

Is there OMI on this ECG?

Why is ECG machine use? What diseases can EKG monitor detect?

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Physical Examination as a Helpful Aid in Decision-Making in Challenging ECGs

Hypertrophic Cardiomyopathy

Syncope and Prehospital Cath Lab activation -- What do you think?

Profound ST Elevation in V1-V3. What do you think?

A man in his 70s with weakness and syncope

What will you do for this patient transferred to you who is now asymptomatic?

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

An ECG with only «marginal» change

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

How does Acute Total Left Main Coronary occlusion present on the ECG?

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

Are these Hyperacute T-waves?

Hyperthermia and ST Elevation

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Stay Connected