Dr. Smith's ECG Blog

AUGUST 24, 2012

A young otherwise healthy man presented with 4 hours of sharp 10/10 substernal chest pain. This ECG is diagnostic of anterior STEMI. The distal inferior apical LAD was cut off by distal embolization from LAD culprit. The QRS is at least as important as the ST segment in diagnosing STEMI BP was 160.

Pericarditis 52

Pericarditis STEMI Chest Pain Myocardial Infarction 52

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. The following ECG was recorded: There is an obvious acute inferior STEMI. Whenever there is inferior STEMI, one should think about Right Ventricular STEMI (RVMI). and STE in lead III > STE in lead II.

STEMI 40

STEMI Chest Pain Pulmonary Ultrasound 40

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

The conventional machine algorithm interpreted this ECG as STEMI. In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. See this post of RV MI with both McConnell sign and "D" sign: Inferior and Posterior STEMI. When EMS found her, she was dyspneic and diaphoretic.

Cardiogenic Shock 128

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 128

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. This meets "STEMI criteria" However, there is very high voltage, with a very deep S-wave in V2 and tall R-wave in V4. The morphology is not right for STEMI. What do you think?

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 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

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

DECEMBER 17, 2011

There is inferior STEMI. 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] See down below for explanation if you don't want to watch the video. There was no right sided ECG.

Chest Pain 40

Chest Pain Embolism STEMI Stents 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

Dr. Smith's ECG Blog

DECEMBER 20, 2013

Without seeing the patient, my interpretation of the first ECG was: likely normal variant ST-elevation (early repolarization), with a small possibility of pericarditis, and almost no possibility of acute coronary occlusion (STEMI). and therefore highly unlikely to be STEMI. The ST/T ratio in V6, however, is slightly greater.

Pericarditis 52

Pericarditis Chest Pain Pulmonary 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

FEBRUARY 29, 2016

He denied fevers and chills, abdominal pain, chest pain, or SOB. It is uncommon in the age of reperfusion therapy, as most STEMI get treated reasonably early, before transmural infarct. LV aneurysm puts them at risk for a mural thrombus, which puts them at risk for embolism, especially embolic stroke.

Aneurysm 52

Aneurysm Ischemia Embolism STEMI 52

Dr. Smith's ECG Blog

JANUARY 12, 2023

Written by Pendell Meyers, edits by Smith Two patients presented with acute chest pain/pressure. ECG read as: "Shows T wave inversions in the inferior leads and less than 1mm STE in V2, without STEMI criteria." Chest x-ray was read as normal. CT pulmonary angiogram was negative for pulmonary embolism. Reocclusion!

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

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. Smith's ECG Blog

JULY 11, 2018

A 40-something woman had sudden chest pain. This is of course diagnostic of an acute coronary occlusion MI (OMI) that also meets STEMI criteria. 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.

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 127

Plaque Angina Blog Stents 127

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 Patient 2 STEMI criteria is based only ST elevation millimeter criteria measured in isolation from the QRS and stratified by age/sex, so this is the only information provided above.

Chest Pain 118

Chest Pain STEMI Myocardial Infarction Blog 118

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 139

Chest Pain Embolism Pulmonary Tachycardia 139

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart Attack 120

Dr. Smith's ECG Blog

DECEMBER 22, 2022

As his pain was very severe, emergency physicians concerned of aortic dissection and ordered a thoracic CT scan. Bi-phasic scan showed no dissection or pulmonary embolism. His pain is now settled a bit, around 4/10 and first troponin turned out to be 12 ng/L (normal <14 ng/L). Turk Kardiyol Dern Ars. 2021 Sep;49(6):488-500.

STEMI 52

STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

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. 50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. Pericarditis?

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

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 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

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. LV Thrombus , 1.5

Myocardial Infarction 52

Myocardial Infarction Pericarditis STEMI Angina 52

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. NSTEMI-OMI").

Chest Pain 121

Chest Pain STEMI Stents Stent 121

Dr. Smith's ECG Blog

FEBRUARY 16, 2025

The emergency medicine physician documented, "His initial EKG is riddled with artifact and difficult to interpret but does not look like a STEMI." 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.

STEMI 72

STEMI Pericarditis Chest Pain Echocardiogram 72

Dr. Smith's ECG Blog

APRIL 9, 2025

A middle-age woman with no previous cardiac history called 911 for chest pain. The paramedics diagnosis was "Possible Anterolateral STEMI." LAD: type III-IV vessel with a proximal thrombotic or embolic occlusion (TIMI 0 flow). More proof that a huge STEMI may have normal or near normal initial troponin.

Defibrillator 63

Defibrillator Cardiac Arrest Myocardial Infarction STEMI 63

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. The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI".

STEMI 121

STEMI Chest Pain Myocardial Infarction Aneurysm 121

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 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75