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.

Chest Pain 52

Chest Pain Congenital Heart Disease Article Congenital 52

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.

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

DAIC

APRIL 1, 2024

Sengupta, who is also Chief of Cardiology at Robert Wood Johnson University Hospital, an RWJBarnabas Health facility, is the lead author of a paper in The Lancet explaining which technologies are here now and which are coming soon. “It It will be important that we learn and embrace the winds of change that are imminent.”

Technology 105

Technology Heart Disease Innovation Ultrasound 105

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema. Finally, the presentation is dyspnea, not chest pain. What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. Here is my interpretation: There is sinus rhythm with RBBB.

Aneurysm 124

Aneurysm Stents Stent Chest Pain 124

Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

The patient had experienced one month of chest pains, coughing and hemoptysis symptoms. Ultrasound showed no thrombosis in the veins of both lower limbs. After treatment, the patient's chest pain symptoms were relieved, and there were no symptoms such as difficulty breathing.

Embolism 40

Embolism Pulmonary Chest Pain Thrombosis 40

Dr. Smith's ECG Blog

JUNE 18, 2011

3 hours prior to calling 911 he developed typical chest pain. 1.196 x STE60 in V3 in mm) + (0.059 x computerized QTc) - (0.326 x RA in V4 in mm) Third, one can do an immediate cardiac ultrasound. Medics gave him nitroglycerine sublingual and his pain resolved. greater than 23.4 is likely anterior STEMI).

STEMI 52

STEMI Pericarditis Hospital Aneurysm 52

Dr. Smith's ECG Blog

APRIL 26, 2017

There was no chest pain or SOB at the tim of the ECG: Computerized QTc is 464 ms A previous ECG from 8 years prior was normal. My opinion was that it was not a cath lab case, but I did suggest they do a bedside ultrasound to look for an anterior wall motion abnormality. I had not seen the cardiac ultrasounds at this time.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

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. Vitals were HR 58 BP 167/70 R20 sat 96%.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 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. Now another, with ultrasound.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

APRIL 20, 2018

female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chest pain for the past four hours. This is her pre-hospital ECG: This is her first ECG in the ED: What do you think? While she was in her bed at home, she had sudden onset of left sided chest pain that radiated to her shoulder.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. On medic arrival, she walked out of the house in no distress, but was diaphoretic.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

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

NOVEMBER 15, 2023

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Sanjay Gupta

DECEMBER 19, 2022

A 50-year-old lady was admitted to my hospital with crushing chest tightness. She asked me why I felt she had had a heart attack and I explained to her that she had had chest pains and the blood test indicating damage to the heart was elevated and that was all we needed to say that she had had a heart attack.

Heart attacks 40

Heart attacks Heart Attack Blood Clot Chest Pain 40

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)?

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Sanjay Gupta

DECEMBER 19, 2022

About 5% of patients who present to A+E with chest pain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis. Who needs to stay in hospital? a pericardial effusion) then it is perhaps a good idea to stay in hospital as the features point to a more complicated course.

Pericarditis 40

Pericarditis Heart Attack Heart attacks Chest Pain 40

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Case A 47 year old male called 911 for severe chest pain. A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chest pain with radiation to the anterior neck, with associated nausea. The patient had never had pain like this before. He was clammy and looked unwell.

Ischemia 40

Ischemia Chest Pain STEMI Stenosis 40

Dr. Anish Koka

SEPTEMBER 24, 2022

The current study should dispel the ludicrous notion that clinical myocarditis - a disease entity that comes to light when you have chest pain because cells in your heart are dying — is mild. So, of the 989 cases of myocarditis that were identified via VAERS, there is information on hospitalization status for 519 of them.

COVID-19 52

COVID-19 Hospital Chest Pain Quality of Life 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

To, me these look like anterior wall motion abnormality, but I showed them to one of our ultrasound fellows who is very interested in this. Serial ECGs correlated to the presence ( and severity ) of chest pain — often reveal the status of the "culprit" artery (ie, occluded, reopened, reoccluded ). She said: This is a tough one.

STEMI 40

STEMI Chest Pain Hospital Risk Factors 40

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

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Dr. Nossen performed a bedside ultrasound which was interpreted as normal. See these similar cases: A man in his sixties with chest pain Why is there inferior ST elevation, and would you get posterior leads? Sudden CP and SOB with Inferior ST Elevation and in STE in V1. Is it inferior and RV OMI?

Blog 52

Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. Thus, hypokalemia is prevalent immediately after out-of-hospital cardiac arrest, whereas it is uncommon in AMI in the absence of cardiac arrest.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

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. Smith comment: This patient did not have a bedside ultrasound. In fact, bedside ultrasound might even find severe aortic stenosis. What should be done?

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

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). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. orthostatic vitals b.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

MARCH 6, 2020

This middle-aged man with no cardiac history but with significant history of methamphetamin and alcohol use presented with chest pain and SOB, worsening over days, with orthopnea. A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function. BP:143/99, Pulse 109, Temp 37.2 °C

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. She awoke in the morning with sharp chest pain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. Smith's ECG Blog

NOVEMBER 19, 2024

These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. The pain was relieved by one prehospital NTG spray. Initial high sensitivity Troponin I: 36.5 (ng/L)

STEMI 110

STEMI Ultrasound Blog Chest Pain 110

Dr. Smith's ECG Blog

MARCH 17, 2025

Written by Willy Frick A man in his 60s with a history of hypertension and 40 pack-year history presented to the ER with 1 day of intermittent, burning substernal chest pain radiating into both arms as well as his back and jaw. It has been stuttering, lasting 10 minutes at a time with associated diaphoresis.

STEMI 81

STEMI Chest Pain Myocardial Infarction Document 81