Chest Pain, Embolism and Pericarditis

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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

Chest Pain Embolism Pulmonary Tachycardia

"Pericarditis" strikes again

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

Pericarditis Chest Pain Aortic Blog

Vomiting, Diarrhea, and "Bubbles in my Chest"

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

Pericarditis Chest Pain Bradycardia Aortic

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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. But there was some doubt as to whether it might be pericarditis because of the ST elevation in I and II, without ST depression in III. This is a good sign for myocardial infarction and does not happen in pericarditis. BP was 160.

Pericarditis

Pericarditis STEMI Chest Pain Myocardial Infarction

Noisy, low amplitude ECG in a patient with chest pain

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

Chest Pain Blog Arrhythmia Critical Care

31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

Dr. Smith's ECG Blog

DECEMBER 20, 2013

Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?

Pericarditis

Pericarditis Chest Pain Pulmonary Embolism

A man in his 50s with shortness of breath

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

Chest Pain Embolism Pulmonary Ischemia

ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

Chest Pain

Chest Pain STEMI Blog Embolism

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. CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

What is lurking underneath this new right bundle branch block?

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

Chest Pain Pericarditis Embolism Stents

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. Such an out-of-proportion STE is virtually never seen in pericarditis. STE in lead I and II are more subtle.

Chest Pain

Chest Pain Myocardial Infarction Blog Pericarditis

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. Patients with completed, transmural infarct are also at risk for post-infarction regional pericarditis and myocardial rupture. LV aneurysm puts them at risk for a mural thrombus, which puts them at risk for embolism, especially embolic stroke.

Aneurysm

Aneurysm Ischemia Embolism STEMI

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. Myocardial Rupture and Postinfarction Pericarditis.

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

Quiz post: do either or both of these patients have high lateral OMI / South African flag sign?

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

Chest Pain STEMI Blog Stenosis

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. The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” But ECG #1 is not "normal".

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

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

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

Dr. Smith's ECG Blog

FEBRUARY 16, 2025

This is a very bold statement in a type 1 diabetic with very concerning sounding chest pain. The patient was treated with aspirin and a GI cocktail, which did not help the pain. Even if it is not atherosclerotic, young people can have embolic OMIs. The emergency physician consulted cardiology.

STEMI

STEMI Pericarditis Chest Pain Echocardiogram

Cardiovascular Update

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

"Pericarditis" strikes again

Vomiting, Diarrhea, and "Bubbles in my Chest"

Webinars

Pericarditis, or Anterior STEMI? The QRS proves it.

Noisy, low amplitude ECG in a patient with chest pain

31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

A man in his 50s with shortness of breath

ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes

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

What is lurking underneath this new right bundle branch block?

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

Nausea and Vomiting. This ECG is loaded with information.

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

Quiz post: do either or both of these patients have high lateral OMI / South African flag sign?

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

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

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

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