Chest Pain Exercise STEMI 
Dr. Smith's ECG Blog
JUNE 11, 2024
Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. Now it is a full blown STEMI of 3 myocardial territories: inferior, posterior, and lateral But at least it does not call it "Normal." No further follow up is available.
Dr. Smith's ECG Blog
MAY 19, 2022
Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. Exercise test would also have been reasonable. Read about "exercise induced cardiac troponin elevations" here.
Dr. Smith's ECG Blog
APRIL 22, 2022
Written by Jesse McLaren, with comments from Smith and Grauer A 60 year old presented with three weeks of intermittent non-exertional chest pain without associated symptoms. A prospective validation of the HEART score for chest pain patients at the emergency department. Backus BE, Six AJ, Kelder JC, et al.
Dr. Smith's ECG Blog
DECEMBER 9, 2011
This ECG comes from Tom Bouthillet, who is devoted to good STEMI care, runs the EMS12lead ECG site , and who has also produced an outstanding iPhone/iPad/Android 12-lead ECG challenge App for learning to recognize subtle STEMI and to differentiate STEMIs and look alikes. There is 0.5 mm of ST depression in aVL.
Dr. Smith's ECG Blog
AUGUST 2, 2024
Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain. This was a machine read STEMI positive OMI. His ECG is shown below. Pretty obvious anterior current of injury. Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4.
Dr. Smith's ECG Blog
JULY 3, 2018
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. The pain initially started the day prior to presentation. LAD occlusion. Great case.
Dr. Smith's ECG Blog
SEPTEMBER 18, 2024
Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. He was given aspirin and sublingual nitro and the pain resolved. The history is concerning ( This patient was awakened from sleep by chest pain that persisted for several hours — on a background of intermittent CP in recent weeks ).
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