Chest Pain, Embolism and Ischemia - Cardiovascular Update

A man in his 50s with shortness of breath

Dr. Smith's ECG Blog

MARCH 26, 2024

There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Aslanger's is a combination of acute inferior OMI plus subendocardial ischemia, and due to the ischemia vectors , it has STE only in lead III. Moreover, there is tachycardia.

Chest Pain

Chest Pain Embolism Pulmonary Ischemia

Chest pain and LBBB. LBBB resolves and there is V1-V3 T-wave inversion.

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

Chest Pain Ischemia STEMI Tachycardia

Off and on chest pain for 24 hours in a 50s year old man

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

Chest Pain Ischemia Stenosis Pulmonary

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

Elder Male with Syncope

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. More detailed reviews of subendocardial ischemia, as well as acute ECG patterns that breach the typical presentation, can be found here: [link] [link] Imaging revealed no acute head, or spinal, injuries.

Ischemia

Ischemia Stenosis Chest Pain Coronary Artery Disease

What does the ECG show in this patient with chest pain, hypotension, dyspnea, and hypoxemia?

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

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter

RBBB with dynamic T-waves

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. Here are V1-V3 from the last 3 ECGs: It is now clear that there is cardiac ischemia. Wraparound?

Chest Pain

Chest Pain Embolism Ischemia Pulmonary

A 60-something with Syncope, LVH, and convex ST Elevation

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

Chest Pain STEMI Ultrasound Pulmonary

Pericarditis, or Anterior STEMI? The QRS proves it.

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. This is likely because 1) the ischemia to the inferior wall was only partial and 2) it reperfused quickly. It has been constant since then.

Pericarditis

Pericarditis STEMI Chest Pain Myocardial Infarction

Nausea and Vomiting. This ECG is loaded with information.

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

He denied fevers and chills, abdominal pain, chest pain, or SOB. Normal RBBB, no evidence of ischemia. 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.

Aneurysm

Aneurysm Ischemia Embolism STEMI

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

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

Coronary Angiogram Plaque Thrombosis STEMI

Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

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

Chest Pain STEMI Ischemia Blog

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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

Plaque Chest Pain Thrombosis Stenosis

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Blood Clots: An enlarged heart is more prone to developing blood clots, which can lead to stroke or pulmonary embolism.

Blood Pressure

Blood Pressure Blood Clot Heart Valves Heart Rhythm

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

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

Chest Pain Aneurysm STEMI Thrombosis

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Thus, this apparently is Aslanger's Pattern (inferior OMI with single lead STE in lead III, with simultaneous subendocardial ischemia).

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

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 Both of these are very suggestive of " No-Reflow ," or poor microvascular reperfusion due to downstream embolization of microscopic platelet-fibrin aggregates. hours when she called 911.

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

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. Left BBB vi. Pathologic Q-waves viii.

Arrhythmia

Arrhythmia Outcomes Chest Pain Risk Factors

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

Chest Pain

Chest Pain Ischemia Plaque Stents

Are there hyperacute T-waves? And how can we know?

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. Watch what happends as the heart recovers from its episode of ischemia. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute? Hard to tell. How can we know?

Coronary Artery Bypass Graft

Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis

A woman in her 40s with acute chest pain and shortness of breath

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. Smith : This is classic for pulmonary embolism (PE). Acute pulmonary embolism was confirmed on CT angiogram: The patient did well. Chest pain, SOB, Precordial T-wave inversions, and positive troponin.

Chest Pain

Chest Pain Embolism Pulmonary Tachycardia

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

Third, a slow motion segment showing delayed, brisk filling of the PDA due to dislodgment of a thrombus from contrast injection and distal embolization. A distal RCA lesion ( blue arrow ), Delayed brisk filling of an initially occluded PDA due to a thrombus dislodged during injection which embolized distally.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

A man in his 50s with shortness of breath

Chest pain and LBBB. LBBB resolves and there is V1-V3 T-wave inversion.

Off and on chest pain for 24 hours in a 50s year old man

Webinars

Elder Male with Syncope

What does the ECG show in this patient with chest pain, hypotension, dyspnea, and hypoxemia?

RBBB with dynamic T-waves

A 60-something with Syncope, LVH, and convex ST Elevation

Pericarditis, or Anterior STEMI? The QRS proves it.

Nausea and Vomiting. This ECG is loaded with information.

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

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

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

Can you localize the culprit lesion on angiogram without taking ECG findings into account?

Are there hyperacute T-waves? And how can we know?

A woman in her 40s with acute chest pain and shortness of breath

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Stay Connected