Chest Pain, Embolism and Myocardial Infarction

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

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.

Chest Pain

Chest Pain STEMI Blog Stents

Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.

Dr. Smith's ECG Blog

DECEMBER 14, 2016

A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. Acute myocardial injury: Is it myocardial infarction, or perhaps myocarditis?

Chest Pain

Chest Pain STEMI Aortic Pulmonary

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

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) - A Double-blind, Randomized Placebo Procedure-controlled Trial of an Interatrial Shunt in Patients with HFrEF and HFpEF: Principal Results From the RELIEVE-HF Trial - Empagliflozin After Acute Myocardial Infarction: Results of the EMPACT-MI Trial - CSL112 (Apolipoprotein A-I) Infusions and Cardiovascular Outcomes in Patients (..)

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

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Abstract 4135360: Eosinophilic Myocarditis: An Atypical Presentation with a Labile Course: A Case Report

Circulation

NOVEMBER 11, 2024

Case presentation:A 64-year-old man presented with one day of chest pain. TTE showed a reduced EF with multiple segmental abnormalities concerning for myocardial infarction. Air embolism from ECMO decannulation is another possibility, though air embolisms may include cerebrovascular pathology, which was not observed.

Myocardial Infarction

Myocardial Infarction Coronary Angiogram Echocardiogram Chest Pain

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. Add that to "sharp" pain and a 33 year old, and it is easy to convince yourself that this is, indeed, pericarditis. This is a good sign for myocardial infarction and does not happen in pericarditis. BP was 160.

Pericarditis

Pericarditis STEMI Chest Pain Myocardial Infarction

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

Sometimes even ST Elevation meeting criteria is not enough to be convincing

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. The ECG in ER is shown below: ECG is still diagnostic but we are watching the natural course of myocardial infarction here.

Chest Pain

Chest Pain Myocardial Infarction Blog Pericarditis

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

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

Coronary Angiogram Chest Pain Stenosis STEMI

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

See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. International Journal of Cardiology Heart & Vasculature Case A 40-year-old man presents with excruciating back pain which has started 1 hour ago. References 1. 2021.21026.

STEMI

STEMI Chest Pain Myocardial Infarction Electrocardiogram

MINOCA : When a heart attack is not a heart attack

Dr. Sanjay Gupta

DECEMBER 19, 2022

The term MINOCA stands for Myocardial infarction with non-obstructive coronary arteries. A 50-year-old lady was admitted to my hospital with crushing chest tightness. Cardiac Causes Myocarditis – an infection of the heart may cause damage to the heart muscle and cause chest pain.

Heart Attack

Heart Attack Heart attacks Blood Clot Chest Pain

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 Appearance of abnormal Q waves early in the course of acute myocardial infarction: implications for efficacy of thrombolytic therapy. hours when she called 911. These do NOT indicate late, subacute MI.

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

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. But which myocardial walls are affected? However, by the time of the angiogram it had embolized distally, and had only done so after the right sided ECG was recorded. She called 911. This prehospital ECG was recorded: Here are limb leads: Here are precordial leads: Diagnosis?

Chest Pain

Chest Pain STEMI Ischemia Blog

Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?

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. Hyperacute T waves can be a useful sign of occlusion myocardial infarction if appropriately defined. Acad Emerg Med 2023 3. Smith, Meyers. Ann Emerg Med 2023 4. Meyers, Bracey et al.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

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). Old myocardial infarction, 6. to 1.45) for fatal or nonfatal stroke.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

Myocardial infarction and pulmonary embolism in pancreatic cancer: a case report of two manifestations of Trousseau's syndrome

Frontiers in Cardiovascular Medicine

MARCH 30, 2025

IntroductionThe simultaneous occurrence of acute myocardial infarction (AMI) and venous thromboembolism (VTE) is rare and often associated with underlying malignancies. Subsequent investigations revealed pulmonary embolism, deep vein thrombosis, and imaging findings suggestive of pancreatic cancer.

Myocardial Infarction

Myocardial Infarction Embolism Cancer Pulmonary

Pay now (in the evening) or pay later with interest (in the middle of the night).

Dr. Smith's ECG Blog

MARCH 1, 2025

A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. The chest pain continued for hours. hours, another ECG was recorded.

Chest Pain

Chest Pain STEMI Stents Stent

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. SanzRuiz, R., Tang, Z.,

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

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. By itself seeing this ECG pattern does not necessarily mean that the patient has a pulmonary embolism. 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

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. He presented to the ED for evaluation chest pain. Pain was improved but not gone upon arrival.

STEMI

STEMI Chest Pain Myocardial Infarction Aneurysm

Cardiovascular Update

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.

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

Webinars

Abstract 4135360: Eosinophilic Myocarditis: An Atypical Presentation with a Labile Course: A Case Report

Pericarditis, or Anterior STEMI? The QRS proves it.

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

Sometimes even ST Elevation meeting criteria is not enough to be convincing

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

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

See OMI vs. STEMI philosophy in action

MINOCA : When a heart attack is not a heart attack

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

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

Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?

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

Myocardial infarction and pulmonary embolism in pancreatic cancer: a case report of two manifestations of Trousseau's syndrome

Pay now (in the evening) or pay later with interest (in the middle of the night).

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

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

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

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