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. Prateek Bhatnagar

MAY 11, 2022

A 55 years old diabetic male patient who had 12 stents in his heart underwent a successful beating heart bypass surgery under Dr. Prateek Bhatnagar, Director Cardiac Surgery. The patient was suffering with angina (chest pain) since 2002. The last 3 stents were placed just 6 months back but were not working.

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Stents Stent Chest Pain Diabetes 52

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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Chest Pain Aneurysm STEMI Document 52

Dr. Paddy Barrett

DECEMBER 5, 2023

The logic of stenting obstructed coronary arteries is simple. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. But coronary stenting is not the only way to reduce symptoms of angina. All is fixed.

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Stents Stent Angina Heart Attack 59

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 126

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

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

NOVEMBER 17, 2023

It is of an elderly woman who complained of shortness of breath and had a recent stent placed. Also, we know the patient had a stent. Finally, the presentation is dyspnea, not chest pain. A few days before that, she had had an LAD stent for LAD occlusion. I was texted this ECG just as I was getting into bed.

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Aneurysm Stent Stents Chest Pain 124

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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Chest Pain STEMI Aneurysm Pericarditis 52

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. The door to balloon time was incredibly short and there was a 100% circumflex occlusion that was opened and stented.

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Hospital Chest Pain Blog Pulmonary 77

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

Ken Grauer, MD

AUGUST 26, 2023

As discussed in many posts in this ECG Blog — despite not satisfying the millimeter-based definition of a STEMI — in this patient with new chest pain, the ECG findings in Figure-1 merit prompt cath lab activation without any need to wait for serum troponin to return elevated ( See ECG Blog #193 — regarding the new "OMI" paradigm ).

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Blog Chest Pain STEMI Ischemia 145

Ken Grauer, MD

OCTOBER 25, 2024

P.S.: Cardiac cath was performed — and showed a distal LA D "culprit" lesion that was successfully stented. The following are the KEY clinical and ECG features that establish the diagnosis of W ellens ' S yndrome : There should be a history of prior chest pain that has resolved at the time the defining ECG is obtained.

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Dr. Smith's ECG Blog

OCTOBER 2, 2021

Submitted by Benjamin Garbus, MD with edits by Bracey, Meyers, and Smith A man in his early 30s presented to the ED with chest pain described as an “explosion" of left chest pressure. He had been seen several weeks ago at an outside hospital for a similar issue and had been discharged home, presumably after unremarkable workup.

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Chest Pain Ultrasound STEMI Myocardial Infarction 52

DAIC

APRIL 11, 2024

At two years, people who underwent preventive PCI were 89% less likely to experience the composite primary endpoint of cardiac death, heart attack in the target vessel, revascularization due to ischemia in the target vessel or hospitalization for unstable or progressive chest pain compared with people who received medications alone.

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Plaque Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

He was admitted to the hospital for evaluation of these symptoms — but no ECG was done at that time. On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast. The patient was given opiates which improved his chest pain to 7/10. The proximal LAD is now widely patent.

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Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

JANUARY 31, 2020

I immediately looked for old charts, which were only available from another hospital, and an old echo confirmed inferior "akinesis" (which may also have persistent ST elevation). The patient's chest pain had resolved by the time of the ECG 2. Angiogram: Widely patent RCA and LAD stents. Therefore, no stent was placed. (No

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Angina Stents Stent Aneurysm 52

Heart BMJ

AUGUST 14, 2024

Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.

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Aneurysm Chest Pain Myocardial Infarction Thrombosis 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

He was treated for infection and DKA and admission to hospital was planned. While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. He later developed mild continuous chest pain, that he describes as the sensation of someone standing on his chest.

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

HeartRhythm

SEPTEMBER 8, 2024

While in the hospital, he had witnessed ventricular fibrillation (VF) arrest for which he received external defibrillation. He had minimal in-stent restenosis on angiography but had only minimal cardiac enzyme elevation and did not have antecedent chest pain before either of his events.

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Heart 2023 Conference

MARCH 5, 2023

Ella Dunmore, who is a mother and former soldier, made the decision to seek medical attention, she had been experiencing headaches, chest pain, and shortness of breath for several weeks. John Hospital in Detroit and director of mechanical circulatory support. Ella went back to her house the following day.

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Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. Patient 1 remained in the hospital overnight.

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Chest Pain STEMI Echocardiogram Stents 116

DAIC

MAY 14, 2024

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death.

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Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

Dr. Anish Koka

MAY 16, 2023

This means that at every age, the probability a man complaining of chest pain has significant underlying coronary disease as a cause of this chest pain is much higher than a woman complaining of chest pain. Thanks for reading Dr. The data is overwhelming every way you can possibly look at it.

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Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chest pain. So the RCA was stented.

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Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 22, 2024

He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. Successful primary angioplasty of the mid-circumflex artery towards the main marginal branch with the implantation of a drug-eluting stent. You must record frequent serial ECGs for patients with chest pain.

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Chest Pain STEMI Myocardial Infarction Angioplasty 66

Dr. Smith's ECG Blog

JULY 2, 2023

This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." Chest pain or discomfort) What do you think? The total duration of chest pain was 30-45 minutes.

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Chest Pain Angina Coronary Angiogram Blog 52

Dr. Smith's ECG Blog

OCTOBER 12, 2023

She was admitted to the hospital with clinical signs of infection. Decision was made to stent the lesion. ECG#4 (below) was recorded about one year after the hospital stay described above. * During ECG #1 patient was febrile with a temperature of 40 °C, (104 °F) * Maximum Troponin I was 4210ng/L. What do you think?

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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. On day 3 of hospitalization she underwent coronary angiography, revealing a 95% lesion in the mid-LAD which was stented. There is sinus rhythm with PACs and PVCs.

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Dr. Smith's ECG Blog

MARCH 9, 2017

Case A 42-year-old lady presented to the ED with complaints of intermittent episodes of chest pain associated with shortness of breath for the last 2 days. This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. This case was written by Sam Ghali: ( @EM_RESUS ). Normal ECG.”

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Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

Written by Pendell Meyers, edits by Steve Smith A man in his 60s with history of hypertension and MI 10 years ago, with PCI, presented to an outside hospital complaining of chest pain that started while mowing the lawn. The LAD lesion was acute and required 3 stents to restore flow.

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Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. The patient was sent home with a prescription for omeprazole to treat presumed peptic disease.

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Outcomes Stenosis Outpatient Echocardiogram 113

Dr. Smith's ECG Blog

JUNE 12, 2017

This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chest pain. It is a matter of time." Do you want to see it? It is not subtle any more.

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Dr. Smith's ECG Blog

NOVEMBER 3, 2017

This is the initial ED ECG of a 46 year old male with chest pain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 Case 4 Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 Case 1 Acute anterior STEMI from LAD occlusion, or Benign Early Repolarization (BER)?

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Dr. Smith's ECG Blog

SEPTEMBER 22, 2019

Troponin profile The patient underwent angiography and had a 90% thrombotic proximal LAD lesion that was stented. I focus my attention on the first 2 ECGs, both of which were done prior to arrival in the hospital. The patient is a 40-something year old man with new chest pain.

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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. He arrived to our hospital one hour later. STE in lead I and II are more subtle. A second ECG was taken at 15:16.

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