Dr. Smith's ECG Blog

MARCH 22, 2024

Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown: What do you think? What do you think?

Chest Pain 114

Chest Pain STEMI Bradycardia Ischemia 114

Dr. Smith's ECG Blog

JANUARY 27, 2024

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab? What do you think?

Chest Pain 117

Chest Pain STEMI Aneurysm Stents 117

MIBHS

FEBRUARY 15, 2025

High blood pressure, also known as hypertension, is a common condition that affects millions of people worldwide. Often referred to as the silent killer, hypertension can quietly damage your heart and other vital organs over time. Hypertension is diagnosed when blood pressure consistently reads 130/80 mm Hg or higher.

Blood Pressure 52

Blood Pressure Hypertension Chest Pain Aneurysm 52

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. Past medical history included diabetes and hypertension.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

JANUARY 31, 2024

A 60-something male presented stating that he had had chest pain that morning which awoke him from sleep but then resolved after several minutes. He has had similar pain in the past which he attributed to acid reflux. He has a history of untreated hypertension. He is pain free now. His systolic BP was 200.

Chest Pain 109

Chest Pain Aneurysm Myocardial Infarction Hypertension 109

Dr. Smith's ECG Blog

OCTOBER 22, 2017

He stated that it is "an acute change from previous" in an elderly smoker with hypertension, syncope, and abdominal pain. 33 yo male with 2 days of chest pain This was an anterior STEMI that had apical ballooning and was wrongly thought to be Takotsubo Diffuse ST Elevation with Apical Ballooning: is it Takotsubo Stress Cardiomyopathy?

Chest Pain 52

Chest Pain STEMI Cardiomyopathy Ultrasound 52

Dr. Smith's ECG Blog

MAY 29, 2017

He had had several episodes of pain since onset; it was described as pressure-like and lasts about 5-15 minutes and resolves spontaneously. He had been pain free for about an hour. He had some "pre-diabetes ," but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day.

Chest Pain 52

Chest Pain Ischemia Circulation Heart Disease 52

Dr. Smith's ECG Blog

JUNE 19, 2024

Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. He described his chest pain as pleuritic and reported that it started the day prior while swinging a golf club. His pain suddenly became much worse in the ED and he became acutely diaphoretic, dizzy, and hypotensive.

Chest Pain 60

Chest Pain Pericarditis Pacemaker STEMI 60

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

MAY 11, 2019

male was sitting at a work conference when he began having substernal chest pain with diaphoresis. He had a history of hypertension, but no history of heart problems. The pain was 7 out of 10 when this ECG was recorded: The QTc = 375 What do you think?

Chest Pain 52

Chest Pain STEMI Stents Stent 52

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.

Chest Pain 52

Chest Pain STEMI Blog Stenosis 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.

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

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. She is somewhat hypertensive, but her vital signs are otherwise normal. 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.

Chest Pain 52

Chest Pain Aneurysm STEMI Document 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Case submitted by Rachel Plate MD, written by Pendell Meyers A man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia.

Chest Pain 52

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack 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

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 Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 14, 2023

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. What About Lead V4?

Chest Pain 52

Chest Pain STEMI Stents Stent 52

Dr. Smith's ECG Blog

JUNE 5, 2024

He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder. The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. It is unclear if the patient was pain free at this time.

Chest Pain 122

Chest Pain Blog Cardiac Arrest Cardiomyopathy 122

Dr. Smith's ECG Blog

APRIL 9, 2023

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell Meyers A man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

The British Journal of Cardiology

MARCH 7, 2024

The National Institute for Health and Care Excellence (NICE) advise against routine testing for coronary artery disease (CAD) in patients with non-anginal chest pain (NACP). Patients in group 3 were more likely to be hypertensive (p=0.008) and have higher Qrisk2 scores (p<0.001) when compared with those in group 1.

Coronary Artery Disease 40

Coronary Artery Disease Chest Pain Risk Factors Hypertension 40

Dr. Smith's ECG Blog

AUGUST 14, 2023

Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chest pain, hypotension, dyspnea, and hypoxemia. Chronic RVH is due to chronic pulmonary hypertension, and these patients are extremely difficult to manage when they are acutely ill. Lots of info here.

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

JULY 7, 2023

An 80-something woman who presented with chest pain and dyspnea. An old formal echo was found from 6 mo ago: Dilated right ventricle with septal flattening and estimated right ventricular systolic pressure of 70 mmHg (significant pulmonary hypertension). After all, this patient did also present with chest pain. ) — See below.

Chest Pain 52

Chest Pain AFIB Blog Atrial Fibrillation 52

Dr. Smith's ECG Blog

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. What do you think? This ECG is more difficult.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Frontiers in Cardiovascular Medicine

FEBRUARY 18, 2025

Non-ischemic phenotypes differed in the prevalence of hypertensive response, reduced CR, and reduced HRR. ConclusionsFour non-ischemic phenotypes of low-risk NSTE-ACS patients were identified: near-normal type, inotropic insufficiency type, hypertensive type, and chronotropic insufficiency type.

Chest Pain 52

Chest Pain Exercise Angina Coronary Artery Disease 52

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Interestingly, this patient was seen in the ED for hypertension and headache 3 days earlier. Sent by Pete McKenna M.D.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. <0.049 ng/mL).

Chest Pain 131

Chest Pain Myocardial Infarction Blog Stents 131

Dr. Smith's ECG Blog

APRIL 12, 2013

He had no chest pain. The computer read is: **Acute MI ** The protocol for prehospital activation in the EMS system that this patient presented to requires 2 elements: 1) Chest pain 2) A computer read of **Acute MI ** Only 1 of 2 was present, so there was no prehospital activation. The patient was transported to the ED.

STEMI 52

STEMI Pulmonary Stents Stent 52

American College of Cardiology

DECEMBER 10, 2024

A 63-year-old woman presents to the office for a second opinion on chronic chest pain and heart failure management. She has a medical history of mixed connective tissue disease, obstructive sleep apnea, hepatic steatosis, and long-standing hypertension diagnosed in her twenties.

Chest Pain 53

Chest Pain Cardiomyopathy Heart Failure Hypertension 53

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

A VSR is more likely to occur in patients who are older, female, hypertensive, have chronic kidney disease, and have no prior history of smoking. Not all patients with acute ( or recent ) MI have chest pain with their event. I thought the presentation of today's case makes it worthwhile to review the data regarding this issue.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Circulation

NOVEMBER 11, 2024

Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. Length of stay (LOS) in the CPU to discharge was 10.4

Chest Pain 40

Chest Pain ACE Inhibitor Cardiac Function Coronary Artery Disease 40

Dr. Smith's ECG Blog

MARCH 26, 2024

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. Chest pain, SOB, Precordial T-wave inversions, and positive troponin.

Chest Pain 69

Chest Pain Embolism Pulmonary Ischemia 69

Dr. Smith's ECG Blog

MAY 5, 2024

He learned more about the patient: A 77 year old female with a past medical history of hypertension and hyperlipidemia presented to the ED at around 0520 after waking up at 0400 with 10/10 chest heaviness radiating to both arms. The patient had continued to have chest pain.

EKG Technician 124

EKG Technician Chest Pain Blog STEMI 124

ECG Guru

JULY 26, 2023

This is the ECG of an 81-year-old man with hypertension. Currently, he has no complaints: no palpitations, no shortness of breath, no syncope, no chest pain. The rhythm is irregular, but all P-waves have the same shape. There are no consequences for the patient resulting from this diagnosis.

Arrhythmia 52

Arrhythmia Chest Pain Hypertension 52

ECG Guru

JULY 26, 2023

This is the ECG of an 81-year-old man with hypertension. Currently, he has no complaints: no palpitations, no shortness of breath, no syncope, no chest pain. The rhythm is irregular, but all P-waves have the same shape. There are no consequences for the patient resulting from this diagnosis.

Chest Pain 52

Chest Pain Arrhythmia Hypertension 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. See this case: A man his 50s with chest pain.

Myocardial Infarction 123

Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast.

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart Attack 120