Dr. Smith's ECG Blog

JULY 23, 2024

I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. This was a weekend late evening, and so it took time the cath team to get in to the hospital. They recorded a prehospital ECG at 2112 and said that it was “normal”. So I uncrumpled it: What do you think?

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Chest Pain Critical Care STEMI Stents 115

The New England Journal of Medicine

JANUARY 22, 2025

A 54-year-old male athlete was evaluated at this hospital because of exertional dyspnea and chest pain. Physical examination revealed jugular venous distention and Kussmauls sign. A diagnosis was made.

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Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think?

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Chest Pain STEMI Outcomes Electrocardiogram 119

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. The patient had a protracted hospitalization and did not survive.

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Dr. Smith's ECG Blog

JANUARY 8, 2024

Let me tell you about her hospitalization, discharged 1 day prior, but it was at another hospital (I wish I had the ECG from that hospitalization): The patient is 40 years old and presented to another hospital with chest pain and SOB. Probably because of a high troponin with chest pain.

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All About Cardiovascular System and Disorders

APRIL 10, 2024

It is not always possible to be certain about the origin of chest pain just by its characteristics as the variation between individuals is quite a bit. A medical opinion should be sought in case of any significant chest pain so that important ailment is not missed. A pain lasting more than 30 minutes is usual.

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Medical Xpress - Cardiology

MAY 1, 2024

Despite ChatGPT's reported ability to pass medical exams, new research indicates it would be unwise to rely on it for some health assessments, such as whether a patient with chest pain needs to be hospitalized.

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ECG Weekly Workout

JANUARY 7, 2024

The following ECG is obtained on arrival before the patient is hospitalized for pyelonephritis, chest pain, and syncope: Case ECG Before watching this week’s video. She is also noted to be febrile at triage, with reported malaise, vomiting, and unilateral back ache. Would you have activated the cath lab?

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Open Heart

JUNE 29, 2023

Contemporary data on recurrent AMI and its association with return emergency department (ED) visits for chest pain are needed. Methods This Swedish retrospective cohort study linked patient-level data from six participating hospitals to four national registers to construct the Stockholm Area Chest Pain Cohort (SACPC).

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Dr. Smith's ECG Blog

FEBRUARY 6, 2023

Sent by anonymous, written by Pendell Meyers A man in his 60s presented with acute chest pain with diaphoresis. Admitted to the hospital service for further evaluation and management." The Importance of the History: As noted above — the onset of chest pain in today's case was acute.

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Dr. Smith's ECG Blog

MARCH 13, 2023

A 40-something woman called 911 in the middle of the night for Chest pain that was intermittent. On arrival, she complained of severe pain. The medics had recorded this ECG and were uncertain whether it was recorded during chest pain: Let's get a better image with use of the PM Cardio app : What do you think?

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Chest Pain Myocardial Infarction Angioplasty Thrombosis 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

There were no injuries and no chest pain and he appeared well. He complained of 3 days of diarrhea and abdominal pain. Pretest probability: Especially when there is no Chest pain, or there are very atypical symptoms, one should be very suspicious of the diagnosis of coronary occlusion unless the ECG is crystal clear.

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Dr. Smith's ECG Blog

DECEMBER 14, 2022

Sent by Drew Williams, written by Pendell Meyers A man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin.

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Dr. Smith's ECG Blog

NOVEMBER 26, 2015

52-year-old lady presents to the Emergency Department with 2 hours of chest pain, palpitations & SOB. Without them the diagnosis is often tough and one must often rely on other clinical data- serial ECG’s, troponin, on-going chest pain, etc. This was written by Sam Ghali ( @ EM_RESUS ), with a few edits by me.

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Dr. Smith's ECG Blog

NOVEMBER 10, 2017

This was sent to me by a former resident from a community hospital: A middle-aged woman complained of chest pain and was seen in triage. She had a ECG recorded. The computer interpreted the ECG (GE Marquette 12 SL) as: "Sinus Bradycardia. Normal ECG." It was not seen by a physician. And the computer will not help you.

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Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin.

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Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

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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. It was not relieved by anything. He had no previous medical history. This includes: 1.

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Chest Pain STEMI Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 10, 2019

This is a previously healthy male teenager who was awoken by chest pain. He was seen at another hospital and found to have a slightly elevated troponin, then underwent a CT pulmonary angiogram (PE) protocol which revealed a right sided pneumonia. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain.

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Chest Pain Pericarditis Ischemia Pediatrics 52

Dr. Smith's ECG Blog

MAY 20, 2024

A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.

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Chest Pain Blood Pressure Ischemia STEMI 125

Dr. Smith's ECG Blog

APRIL 21, 2023

Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. So the patient can be diagnosed with acute MI and has recurrent chest pain. What do you think?

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ECG Guru

MARCH 30, 2025

I do not know if this patient has a history of cardiac disease or a recent complaint of chest pain, but T wave inversion and some biphasic T waves makes me think of reperfusion changes, reflecting a recent M.I. We do not have followup on this patient's hospital course or treatment.

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Dysrhythmia RN Chest Pain Electrophysiology 64

ECG Guru

MARCH 30, 2025

I do not know if this patient has a history of cardiac disease or a recent complaint of chest pain, but T wave inversion and some biphasic T waves makes me think of reperfusion changes, reflecting a recent M.I. We do not have followup on this patient's hospital course or treatment.

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Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). Amazingly, he did not suffer any serious complication in hospital.

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Dr. Smith's ECG Blog

APRIL 8, 2022

There is a patient with persistent chest pain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chest pain patient. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Is there STEMI?

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Chest Pain SCAD STEMI Blog 52

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.

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Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

== MY Comment by K EN G RAUER, MD ( 9/17/2020 ): == Todays patient is a previously healthy, 60-something year-old woman who presented with chest pain that began at a reception. We are indebted to Dr. Smith for developing Modified Smith-Sgarbossa Criteria for assessing ST-T wave changes in chest pain patients with LBBB.

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Chest Pain STEMI Blog Myocardial Infarction 52

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. His symptoms of chest pain and shortness of breath were attributed to an asthma exacerbation during exercise.

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Dr. Smith's ECG Blog

JUNE 14, 2017

This case was sent by Dr Avinash Krishnamurthy, a fine emergency medicine resident from Australia Cairns base hospital Case : An adolescent male had a mechanical fall and injured his left shoulder and arm. There was apparently no syncope and he had no bony injuries, but he did complain of left sided chest pain.

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Dr. Smith's ECG Blog

OCTOBER 6, 2024

This patient had the onset of chest pain 24 hours before arrival to the ED. An ECG was recorded immediately at triage and, at this hospital, the Queen of Hearts is routinely used to determine cath lab activation. Here is that ECG: Original ECG What do you think? There is some ST Elevation and slightly hyperacute T-wave in V6.

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Hospital Chest Pain Blog Pulmonary 77

Dr. Smith's ECG Blog

AUGUST 19, 2023

Because the patient had no chest pain or shortness of breath, they were initially diagnosed as gastroenteritis. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. Potassium was normal. Cardiology did not think it was "STEMI", but repeated the troponin. Take home 1.

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Circulation: Cardiovascular Imaging

NOVEMBER 20, 2023

1.88];P=0.768), and cardiovascular hospitalizations (RR, 0.91 [95% CI, 0.59–1.39];P=0.669) 1.39];P=0.669) did not differ significantly between groups.CONCLUSIONS:In patients with stable chest pain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA.

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Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She felt nauseous and lightheaded with no neurologic deficits.

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Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

MARCH 31, 2023

It is from a 50-something with chest pain: What do you think? Up until recently — all computerized ECG interpretation programs that I am aware of used standard millimeter-based STEMI critieria as the basis for determining which chest pain patients should "qualify" for prompt cath with PCI. This was sent to me by a friend.

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DAIC

FEBRUARY 20, 2024

It is one of only two New Jersey hospitals offering the trial to patients. I’m glad we are able to offer this expert care to the community we serve,” said Vito Buccellato , MPA, LNHA, president and chief hospital executive, Jersey Shore University Medical Center.

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Dr. Sanjay Gupta

JANUARY 25, 2022

Dr Sanjay Gupta, a consultant cardiologist at York Hospital, is an expert in POTS, or postural tachycardia syndrome. The post York Hospital Consultant Could Have Treatment to Tackle Long Covid appeared first on Dr Sanjay Gupta Cardiologist. And like Long Covid, POTS often develops following a viral or other infection, Dr Gupta says.

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Dr. Smith's ECG Blog

AUGUST 22, 2020

== MY Comment by K EN G RAUER, MD ( 8/22/2020 ): == The patient is a mid-50s man who presented to the ED for new-onset chest pain of ~1 hour duration. He was still having chest pain in the ED at the time ECG #1 was done ( Figure-1 ). The patient was discharged from the hospital. = Serial troponins were normal.

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