Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

DAIC

JANUARY 3, 2024

Traditional methods of non-invasive ischemia testing (stress EKG , stress echo, SPECT , PET , direct-to-cath) can result in false negatives 20-30 percent of the time, which can lead to undetected disease, and false positives over 50 percent of the time, which can lead to unnecessary invasive procedures. Arbab-Zadeh, Heart Int 2012.

Coronary Artery Disease 59

Coronary Artery Disease Chest Pain Plaque Technology 59

Dr. Smith's ECG Blog

JUNE 28, 2023

RVOT VT: A 40-something without past history presents with wide complex tachycardia and crushing chest pain Regular Wide Complex Tachycardia. A regular wide complex tachycardia in a young patient with no history of heart disease is very likely to be AVRT. No , this requires inferior axis and LBBB morphology. 3 Pathways.

Tachycardia 98

Tachycardia Ultrasound Heart Disease Atrial Fibrillation 98

Dr. Smith's ECG Blog

JANUARY 9, 2024

Are you confident there is no ischemia? The heart rate is about 130 bpm. The heart rate could be compatible with that of a 2:1 conducted atrial flutter. Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Do you agree with this strategy?

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

JANUARY 1, 2024

His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. There is some ST-segment elevation in DII, DIII, aVF, V4-6.

Tachycardia 112

Tachycardia Blog Ischemia Heart Failure 112

Dr. Smith's ECG Blog

JULY 1, 2019

She had a history of chronic respiratory disease and hypoxia, but hypoxia was no worse than normal. Although as a general rule, there should be no ST elevation in RBBB in the absence of ischemia, there sometimes is ST elevation that looks like this. The challenge is magnified when trying to assess BBB tracings for acute ischemia.

Chest Pain 52

Chest Pain Ischemia STEMI Blog 52

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m. 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 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Ken Grauer, MD

APRIL 9, 2023

No chest pain. Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( It may also occur in patients with underlying coronary disease, cardiomyopathy, and/or with digoxin toxicity. Th e patient was hemodynamically stable in association with this rhythm.

Blog 78

Blog Chest Pain Arrhythmia Cardiac Arrest 78

Dr. Smith's ECG Blog

DECEMBER 27, 2018

But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. All bets would be off if instead of no chest pain, this patient had worrisome new-onset symptoms. The Ratios of STE to S-wave: V1: 2.5/16 P EARL : Clinical correlation is KEY in this case.

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Written by Pendell Meyers, few edits by Smith A man in his 60s with history of stroke and hypertension but no known heart disease presented with chest pain that started on the morning of presentation at around 8am. Here is his triage ECG when he presented at 1657: What do you think?

STEMI 52

STEMI Chest Pain Myocardial Infarction Document 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. Is there STEMI? Moffat, M.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

MARCH 15, 2023

This middle-aged patient has a remote history of cardiac surgery as a young child for a "heart murmur". She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. Exam was completely normal except for an irregular heart rate. She was on no medications.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

AUGUST 8, 2020

Weren't you taught that "new tall T wave in V1" is concerning for ischemia, and so this is the opposite? Weren't you taught that concave morphology favors pericarditis? There is also new flattening of the T wave in V1 compared to prior.

Pericarditis 52

Pericarditis STEMI Chest Pain Arrhythmia 52

Dr. Smith's ECG Blog

OCTOBER 25, 2022

She reports that she is now unable to vagal out of her palpitations and is having shortness of breath and dull chest pain. We see a regular tachycardia with a narrow QRS complex and no evidence of OMI or subendocardial ischemia. Her initial EKG is below. As a result — the main indication for treatment is to control symptoms.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Blog 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

She was noted to be tachycardic and her heart sounds were distant on physical exam. Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia.

Pericarditis 40

Pericarditis Tachycardia Ultrasound Blood Pressure 40

MIBHS

OCTOBER 31, 2024

Coronary Artery Disease (CAD) CAD, which involves the narrowing or blockage of coronary arteries due to plaque buildup, can reduce blood flow to the heart. This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Avoid excessive alcohol and drug use.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

DAIC

MAY 14, 2024

Within the complex umbrella of cardiovascular disease, CAD is a type of heart disease that develops when the coronary arteries narrow and the heart cannot deliver enough oxygen-rich blood to the heart.

Coronary Artery Disease 111

Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

Ken Grauer, MD

APRIL 14, 2023

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. The terminology favored to describe these ECG findings is diffuse subendocardial ischemia ( See ECG Blog #271 — for more on diffuse subendocardial ischemia ).

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Blog Chest Pain Ischemia Tachycardia 78

Dr. Paddy Barrett

NOVEMBER 28, 2023

One of the most common questions I get is, “ Do I need a stent to treat my heart disease?” Ischemia Trial In an attempt to clarify this question, a similar trial was done called the Ischemia Trial, which had important differences to the Courage trial but again tried to answer a similar question 3.

Stents 53

Stents Stent Heart Disease Heart Attack 53

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

No chest pain. Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). Later on during the night of his admission he had a short episode of chest pain that resolved with sublingual nitroglycerin. His vitals were initially normal.

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. She had no known heart condition. Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). Even though the primary suspicion was not ischemic heart disease, a CT angiogram was performed, and it revealed normal coronary arteries.

Tachycardia 107

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Anish Koka

MAY 16, 2023

Knowledge of this fundamental pillar of biology should drive how cardiologists approach men and women being evaluated for the presence of significant coronary disease. Atypical angina is classified as having any two of the three symptoms, and non-anginal pain any one of the three symptoms.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart attacks 52

Cardiometabolic Health Congress

MAY 10, 2024

In MSIMI (Mental Stress-induced Myocardial Ischemia) studies , mental stress activities like public speaking were evaluated for their impact on ischemia, measured via myocardial SPECT and vascular function (microvascular function, endothelial function). Combining behavioral and pharmacological treatment is most effective.

Coronary Artery Disease 59

Coronary Artery Disease Obesity Chest Pain Ischemia 59

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He was asked multiple times about chest pain or dyspnea, but repeatedly denied any such symptoms. Patient denied chest pain on initial review of symptoms. Was now endorsing chest pain which began 30 minutes ago. Upon further questioning, he states that he has had intermittent chest pain since yesterday.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

Dr. Paddy Barrett

AUGUST 1, 2023

Share Chest Pain Symptoms There is no role for CT Calcium Scoring in the setting of someone with chest pain symptoms suspected to be from a narrowed coronary artery. This approach also reduces death from heart disease and heart attacks by 41% compared to conventional approaches such as exercise stress testing 2.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Smith's ECG Blog

APRIL 7, 2019

The patient was a 70-something yo previously healthy male on no medications who presented to the ED with epigastric pain, onset over a few hours. He denied chest pain of any sort and his vitals were all normal. They cannot be assumed due to LV strain ( and they cannot be assumed to represent ischemia ).

Chest Pain 52

Chest Pain Ischemia Nursing STEMI 52

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. LBBB is typically the result of preexisting hypertrophy, ischemic heart disease, or cardiomyopathy.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Ken Grauer, MD

OCTOBER 4, 2024

As to ST-T wave changes in the 12-lead ECG — although some leads show T wave inversion (ie, in leads III, V3 and V4 ) — I did not think this looked acute in this 30-year old man without chest pain. Did the patient have some form of underlying heart disease? No evidence of ischemia. What about the Repeat ECG?

Blog 101

Blog Bradycardia Arrhythmia Heart Disease 101

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. h/o heart disease (+1) 3.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. No evidence for ischemia jumps out. ECG 1 What do you think?

Chest Pain 102

Chest Pain Tachycardia Pacemaker Defibrillator 102

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. Denying patients the potential benefit of revascularization just because their symptoms have lasted a certain amount of time shows poor understanding of the pathophysiology of myocardial ischemia. He presented to the emergency department for evaluation.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Dr. Smith's ECG Blog

APRIL 18, 2025

He played a round of golf a week prior and felt an episode of chest pain during the round, which spontaneously resolved. On presentation, he reported no chest pain or shortness of breath. Five days later, the patient was exercising when he developed chest pain at 19:30 which lasted for an hour.

Chest Pain 81

Chest Pain Cardiac Arrest Tachycardia ICU 81