Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

All 9 patients reported profound remission of dyspnea and chest pain after endovascular interventions. m, with an average age of 62.0 ± 16.0 years, and the time from computed tomography pulmonary angiography (CTPA) diagnosis to interventional treatment averaged 2.8 ± 2.2 The operation time for these patients was 106.1 ± 22.2 min,

Embolism 52

Embolism Pulmonary Chest Pain 52

Dr. Smith's ECG Blog

MARCH 26, 2024

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Acute pulmonary embolism was confirmed on CT: The patient did well with treatment. Unfortunately, we don't have those details.

Chest Pain 68

Chest Pain Embolism Pulmonary Ischemia 68

Dr. Smith's ECG Blog

APRIL 9, 2023

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell Meyers A man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

Genetic protein S (PS) deficiency caused by PROS1 gene mutation is an important risk factor for hereditary thrombophilia.Case introductionIn this case, we report a 28-year-old male patient who developed a severe pulmonary embolism during his visit. The patient had experienced one month of chest pains, coughing and hemoptysis symptoms.

Embolism 40

Embolism Pulmonary Chest Pain Thrombosis 40

Dr. Smith's ECG Blog

JUNE 11, 2011

Explanation : The patient had a worrisome history: 59 yo with significant substernal chest pressure, so his pretest probability of MI (and even of STEMI) is reasonably high. Only 5-13% of patients with chest pain and LBBB have MI; many fewer have coronary occlusion. Moreover, and importantly, there was sinus tach.

Chest Pain 52

Chest Pain Ischemia STEMI Tachycardia 52

The British Journal of Cardiology

FEBRUARY 4, 2025

A 50-year-old man presented to the emergency department with symptoms of acute chest pain, dizziness, and headache. If the dissection extends into the aortic arch branches, ensuring adequate cerebral perfusion during surgery is crucial to preventing stroke. His blood pressure was 180/110 mmHg and heart rate was 100 bpm.

Aortic 40

Aortic Blood Pressure Chest Pain Embolism 40

Dr. Smith's ECG Blog

AUGUST 14, 2023

Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chest pain, hypotension, dyspnea, and hypoxemia. The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) An 80-something woman who presented with chest pain and dyspnea.

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2024

Angiogram: Severe 95% hazy distal LM Severe 80% ostial LAD, 100% occluded distal LAD thought to be due to distal embolization from the lesion in the proximal LAD. Post op chest pain Typical of post-op pericarditis (postpericardiotomy syndrome) There is ST Elevation in II ＞ III, and STE in V3-5, but with flat T-wave.

Pericarditis 104

Pericarditis Chest Pain Bradycardia Aortic 104

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

Ken (below) is appropriately worried about pulmonary embolism from the ECG. Finally, the presentation is dyspnea, not chest pain. It is of an elderly woman who complained of shortness of breath and had a recent stent placed. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think?

Aneurysm 123

Aneurysm Stent Stents Chest Pain 123

Dr. Smith's ECG Blog

APRIL 27, 2012

56 y/o male who presented with 12/10 severe chest pain starting at 3AM, radiating to his upper back. He had a history of pulmonary embolism but was no longer on coumadin and states the pain is different. The patient was very hypertensive and had back pain, so they did a CT of his chest to rule out dissection.

Chest Pain 52

Chest Pain Embolism Ischemia Pulmonary 52

Dr. Smith's ECG Blog

APRIL 26, 2017

There was no chest pain or SOB at the tim of the ECG: Computerized QTc is 464 ms A previous ECG from 8 years prior was normal. Absence of chest pain or SOB at the time of the ECG is important; had the patient had active chest pain, I would have recommended at least an emergency formal echo, if not cath lab activation.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

EMS 12-Lead

APRIL 9, 2024

There was no chest pain. V1 and V2 are probably placed too high on the chest given close morphological similarity to aVR. This latter part has been implicated in embolic CVA. The fall was not a mechanical etiology. The ED activated trauma services, and a 12 Lead ECG was captured.

Ischemia 116

Ischemia Stenosis Chest Pain Coronary Artery Disease 116

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. Although it was technically difficult and the quality therefore leaves a lot to be desired, you can still make out RV dilation and septal flattening which is much more suggestive of pulmonary embolism than OMI.

Cardiogenic Shock 126

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 126

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. A new right bundle branch block in a sick patient with chest pain and/or shortness of breath is a worrisome finding concerning for LAD occlusion or significant pulmonary embolism.

Chest Pain 52

Chest Pain Pericarditis Embolism Stent 52

Dr. Smith's ECG Blog

MAY 10, 2023

A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

MARCH 12, 2018

Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG. Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1. Wellens' is a syndrome of a painless period following an anginal (chest pain) event. What is the answer? What is the Diagnosis?

Chest Pain 40

Chest Pain Pulmonary Embolism Tachycardia 40

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

Circulation

NOVEMBER 11, 2024

Case presentation:A 64-year-old man presented with one day of chest pain. Air embolism from ECMO decannulation is another possibility, though air embolisms may include cerebrovascular pathology, which was not observed. Circulation, Volume 150, Issue Suppl_1 , Page A4135360-A4135360, November 12, 2024.

Myocardial Infarction 40

Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain 40

Dr. Smith's ECG Blog

DECEMBER 17, 2011

He took another look and realized that the culprit was indeed in the proximal RCA and that the thrombus had embolized distally. A 56 year old woman with chest pain and hypotension : [link] And so he put the stent in the proximal RCA. Learning point : Even when you have an angiogram, the ECG findings make a difference.

Chest Pain 40

Chest Pain Embolism STEMI Stent 40

Dr. Smith's ECG Blog

AUGUST 24, 2012

A young otherwise healthy man presented with 4 hours of sharp 10/10 substernal chest pain. The distal inferior apical LAD was cut off by distal embolization from LAD culprit. It has been constant since then. He looked ill and diaphoretic. BP was 160. This ECG is diagnostic of anterior STEMI.

Pericarditis 52

Pericarditis STEMI Chest Pain Myocardial Infarction 52

Circulation

NOVEMBER 11, 2024

Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations.

Aortic valve 40

Aortic valve TAVR Chest Pain Aortic 40

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. You may see a filling defect in distal LAD, most probably due to an embolization from proximal lesion. Wait for the angiogram.

Chest Pain 52

Chest Pain Myocardial Infarction Blog Pericarditis 52

Dr. Sanjay Gupta

DECEMBER 19, 2022

She asked me why I felt she had had a heart attack and I explained to her that she had had chest pains and the blood test indicating damage to the heart was elevated and that was all we needed to say that she had had a heart attack. On the basis of these findings we told her that she had suffered a heart attack.

Heart Attack 40

Heart Attack Heart attacks Blood Clot Chest Pain 40

Dr. Smith's ECG Blog

DECEMBER 20, 2013

He said that his pain does not feel like his previous episode of pericarditis, and is not related to meals. He denied chest pain, shortness of breath, nausea, fever, chills, rashes, cough, and leg pain. Does subsegmental pulmonary embolism matter? The ST/T ratio in V6, however, is slightly greater.

Pericarditis 52

Pericarditis Chest Pain Pulmonary STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

No definite evidence of RV hypertrophy (normal axis, no large R-wave in V1) Late transition typical of COPD (R/S = 1 in V5) No evidence of old MI (no QS-waves in V1-V3, as seen in the presenting ECG) Other similar cases of acute right heart strain See this case of asthma whose ECG mimics acute PE: Is it pulmonary embolism? Kosuge et al.

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

JANUARY 12, 2023

Written by Pendell Meyers, edits by Smith Two patients presented with acute chest pain/pressure. Chest x-ray was read as normal. CT pulmonary angiogram was negative for pulmonary embolism. Two patients with chest pain. In a patient with chest pain — this is simply not a "normal" ST-T wave in lead V2.

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

DAIC

FEBRUARY 29, 2024

ET Murphy Ballroom 4 Health 360x Registry: Scalable Workforce for Equitable Access to Point of Care Decentralized Clinical Trials Prevalence of Cardiovascular Disease and Risk Factors Among National Football League Alumni and Their Family Members: Results from the Huddle Study Hózhó (Heart Failure Optimization at Home to Improve Outcomes): A Pragmatic (..)

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

He denied fevers and chills, abdominal pain, chest pain, or SOB. LV aneurysm puts them at risk for a mural thrombus, which puts them at risk for embolism, especially embolic stroke. Patient stated his dry weight is around 85 kg. The emesis is non-bloody and non-bilious. He did have one episode of diarrhea.

Aneurysm 52

Aneurysm Ischemia Embolism 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).

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

JULY 11, 2018

A 40-something woman had sudden chest pain. However, by the time of the angiogram it had embolized distally, and had only done so after the right sided ECG was recorded. Figure-1: Initial ECG, obtained pre-hospital from this 40-ish year old woman with new-onset chest pain ( See text ). She called 911.

Chest Pain 52

Chest Pain STEMI Ischemia Blog 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. This is written by Willy Frick, an amazing cardiology fellow in St.

Plaque 126

Plaque Angina Blog Stent 126

Dr. Smith's ECG Blog

MAY 10, 2014

A male in his late 30's to early 40's presented with 24 hours of intermittent typical chest pain. This is known as McConnell's sign, and is described for Pulmonary Embolism ; here we see it in right ventricular MI. The following ECG was recorded: There is an obvious acute inferior STEMI. The RV is on the left (circled below).

STEMI 40

STEMI Chest Pain Pulmonary Ultrasound 40

Dr. Smith's ECG Blog

JANUARY 17, 2024

Written by Jesse McLaren Two patients presented with acute chest pain, and below are the precordial leads V1-6 for each. Patient 1 (ECG on the left) was a 45 year-old male, and patient 2 (ECG is on the right) was a 70 year-old male. But ECG #1 is not "normal".

Chest Pain 117

Chest Pain STEMI Myocardial Infarction Blog 117

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. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

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

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52