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

JANUARY 9, 2024

She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. She presented to the emergency department after a couple of days of chest discomfort. Answer : The ECG above shows a regular wide complex tachycardia. Cardiac output (CO) was being maintained by the tachycardia.

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

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.

Chest Pain 52

Chest Pain Physiology Blog Stent 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

She presented to an outside hospital after several days of malaise and feeling unwell. Sinus tachycardia has many potential causes. This is especially true for the elderly patient with sinus tachycardia. What is the cause of the sudden tachycardia? At the time of admission, her vital signs were normal.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

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. Is it STEMI or NonSTEMI?

Chest Pain 52

Chest Pain STEMI Aortic Pulmonary 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.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

JULY 25, 2024

Just as important is pretest probability: did the patient report chest pain prior to collapse? For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. After cardiac arrest, I ALWAYS wait 15 minutes after an ECG like this and record another.

Cardiac Arrest 124

Cardiac Arrest Ischemia Tachycardia Defibrillator 124

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. The symptoms can last for years, ruining patients’ lives. Read more here.

POTS 52

POTS Hospital Chest Pain Blood Pressure 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

They had already cardioverted at 120 J, then 200 J, which resulted in the following: Ventricular Tachycardia They then cardioverted at 200 J which r esulted in the same narrow complex rhythm shown above, at 185 beats per minute. This would treat both SVT or sinus tachycardia. I suggested esmolol if the heart rate did not improve.

Tachycardia 52

Tachycardia Chest Pain Pharmacology 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.

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

NOVEMBER 9, 2012

A man in his 40's with a h/o coronary disease complained of sudden dizziness and chest pain. Alternatively, it could be posterior fascicular ventricular tachycardia. Either the PSVT was broken and restarted, or there is sinus tachycardia. Outcome: The etiology of the patient's sinus tachycardia was not discovered.

Tachycardia 52

Tachycardia Chest Pain Hemorrhage Hospital 52

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.

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

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.

Chest Pain 119

Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

Finally, the presentation is dyspnea, not chest pain. This was what was found: She had been at a different hospital less than a week ago at which time she had an an RCA stent for an lesion that had TIMI-3 flow. Patients with anterior LV aneurysm usually have poor LV function and heart failure. What is the Lesson to be learned?

Aneurysm 124

Aneurysm Stent Stents Chest Pain 124

Dr. Smith's ECG Blog

OCTOBER 25, 2023

He did not have chest pain. ECG is consistent with severe hypokalemia and/or hypomagnesemia causing prolonged QT (QU) at high risk of Torsades (which is polymorphic ventricular tachycardia in the setting of a long QT interval). Chest pain in high risk patient. Here is his triage ECG: What do you think? Is it STEMI?

Ischemia 124

Ischemia Chest Pain Cardiac Arrest Blog 124

Dr. Smith's ECG Blog

OCTOBER 18, 2023

A few days into her hospital stay she developed chest discomfort and the following ECG was recorded. The ECG below was on file and was taken a few days earlier, on the day of admission to the hospital. The chest pain quickly subsided. She is healthy with no known cardiac disease. What do you think?

Cardiac Arrest 122

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Chest trauma was suspected on initial exam. The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma? He was intubated for altered mental status.

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Ken Grauer, MD

JUNE 14, 2024

The rhythm is regular — at a rate just over 100/minute = sinus tachycardia ( ie, the R-R interval is just under 3 large boxes in duration ). Continuing with assessment of ECG #1 in Figure-2: The rhythm is sinus tachycardia at ~110/minute. Figure-2: I've labeled the initial ECG. The QRS complex is obviously wide.

Blog 162

Blog STEMI Cardiac Arrest Tachycardia 162

EMS 12-Lead

APRIL 9, 2024

His confusion progressively dissipated enroute to the hospital. There was no chest pain. At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. The fall was not a mechanical etiology. The ED activated trauma services, and a 12 Lead ECG was captured. Type II ischemia.

Ischemia 116

Ischemia Stenosis Chest Pain Coronary Artery Disease 116

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. That said — the important point is her ongoing ( and increasing ) chest pain. C ASE F ollow- U p: The patient's chest pain was controlled.

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Blog Chest Pain Ischemia Tachycardia 78

Dr. Smith's ECG Blog

JANUARY 1, 2024

The patient was promptly admitted to the hospital for further evaluation. Although the patient reported experiencing mild pressure-like chest pain, there was suspicion among clinicians that this might be indicative of an older change. An initial electrocardiogram (ECG) is provided below. What do you think? What is the rhythm?

Tachycardia 112

Tachycardia Blog Heart Failure Ischemia 112

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. The team immediately paged cardiology, concerned for polymorphic ventricular tachycardia. Since sinus conducted QRS complexes cannot co-exist together with ventricular tachycardia, this must all be artifact.

Atrial Fibrillation 81

Atrial Fibrillation Tachycardia Blog Chest Pain 81

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 1 remained in the hospital overnight.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stent 116

Dr. Smith's ECG Blog

OCTOBER 20, 2024

He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The history in today's case with sudden loss of consciousness followed by chest pain is very suggestive of ACS and type I ischemia as the cause of the ECG changes. What do you think?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Circulation: Arrhythmia and Electrophysiology

DECEMBER 21, 2023

Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02) years, colchicine did not reduce a composite of emergency department visit, cardiovascular hospitalization, cardioversion, or repeat ablation (29 versus 25 per 100 patient-years; HR, 1.18 [95% CI, 0.69–1.99];P=0.55).CONCLUSIONS:Colchicine

Atrial Fibrillation 40

Atrial Fibrillation Ablation Chest Pain Atrial Flutter 40

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain. Here is his first ED ECG: What do you see?

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 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. He spent almost 2 months in the hospital, and reportedly made a full neurologic recovery. He was prescribed apixaban.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) What is the Diagnosis in this 70-something with Chest Pain? 68 minutes with chest compressions, full recovery. in-hospital mortality was 18.8% Protocols can be overridden by Physician Judgment.

Chest Pain 52

Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

This strip was obtained: Apparent Wide Complex Tachycardia at a rate of 280 What do you think? Troponins 34>33>43, likely secondary to myocardial injury from tachycardia. Reverted to atrial fibrillation with RVR while in the hospital 3 times and needed cardioversion. Sinus tachycardia does not go this fast.

Atrial Flutter 64

Atrial Flutter Exercise AFIB Tachycardia 64

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. The patient was extubated on Day-3 of the hospital stay. The below ECG was recorded.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

MARCH 11, 2019

After admission to the hospital, the patient was discharged from the hospital without any investigation of his acute MI. In such cases, it is common for tachycardia to exaggerate the ST Elevation And, in fact, there was no new acute MI at this visit - troponins did not rise again. Many MI do not have chest pain 4.

Chest Pain 52

Chest Pain Ischemia Aneurysm Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

MY Thoughts on ECG #1: The rhythm is sinus tachycardia at 105-110/minute. LEARNING Point: Maximal ST depression in leads V2-thru-V4 ( especially when the ST-T waves are shaped as they are in ECG #1 ) in a patient with new chest pain ( or sudden cardiac arrest, as in today’s case ) — is diagnostic of acute Posterior OMI until proven otherwise!

STEMI 52

STEMI Hospital Blog Defibrillator 52

Ken Grauer, MD

AUGUST 29, 2024

PEARL # 2: The way in which I look for flutter waves is to carefully set my calipers at precisely HALF the R-R interval o f the tachycardia ( since IF the rhythm is AFlutter — then the atrial rate should be twice the ventricular rate if there is 2:1 AV conduction ). She was discharged from the hospital on Amiodarone. See text ).

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Blog Chest Pain Tachycardia Heart Disease 157

Wellnest

DECEMBER 21, 2022

Patients use them to observe their heart activity by themselves when they are not in the hospital. Though their accuracy is not as high as a hospital ECG machine, they are very beneficial in detecting problems in any medical emergency and providing information about long-term heart activity.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 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. Now the patient is in sinus tachycardia. Sinus tachycardia, AFlutter and ATach do not do this.

Tachycardia 52

Tachycardia Atrial Flutter Dysrhythmia Ablation 52

Dr. Smith's ECG Blog

MAY 5, 2022

He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. They recommended repeating his ECG and awaiting troponin since the patient did not have any chest pain. He complained of generalized weakness and left lower extremity numbness. What is it?

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. However, STE-aVR with multilead ST depression was associated with 31% in-hospital mortality compared with only 6.2%

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52