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

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. Pre-intervention.

Chest Pain 52

Chest Pain STEMI Stents Stent 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

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. The cath lab was activated.

EKG Technician 123

EKG Technician Chest Pain Blog STEMI 123

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 129

Chest Pain Myocardial Infarction Blog Stents 129

Heart BMJ

AUGUST 14, 2024

Clinical introduction The patient was a man in his 40s with a medical history of hypertension, Behcet’s disease (BD) and chronic renal dysfunction. He was admitted to our hospital with issues of chest pain, shortness of breath and heart palpitations without any obvious inducement.

Aneurysm 52

Aneurysm Chest Pain Myocardial Infarction Thrombosis 52

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 119

Chest Pain Blog Hospital Tachycardia 119

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered.

Chest Pain 81

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 81

Dr. Smith's ECG Blog

JUNE 11, 2021

Case submitted and written by Dr. 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.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

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.

Chest Pain 52

Chest Pain Pericarditis Embolism Stents 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Plan was for admission for chest pain workup. It was stented.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. Fortunately, that is exactly what happened.

Plaque 126

Plaque Angina Blog Stent 126

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. The lesion was successfully stented, but it was unfortunately done after a significant myocardial loss.

Chest Pain 52

Chest Pain Myocardial Infarction Blog Pericarditis 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

This is by Magnus Nossen, from Norway The patient is a 70 something male with a hx of hypertension and tobacco use disorder. The patient contacted EMS after a few hours of chest pain that started 5:30 AM. The pain was described as 6/10 radiating to the right shoulder. The culprit lesion was opened and stented.

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Chest Pain Blog Ischemia Risk Factors 60

Dr. Smith's ECG Blog

DECEMBER 29, 2015

What do you think of this ECG in a patient with chest pain? Case history A middle-aged woman with a history of HTN, but no prior CAD, presented to the ED with chest pain. The pain had been mild and intermittent for 2 weeks, but had become more intense on the night of presentation. Is the ST elevation due to LVH?

STEMI 40

STEMI Myocardial Infarction Chest Pain Aneurysm 40

EMS 12-Lead

MAY 20, 2022

There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. A mid-LAD culprit lesion was identified and stented. Below are two examples of this.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Chest Pain 134

Chest Pain Defibrillator STEMI Coronary Artery Disease 134

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. Here is the angiogram after stent placement.

Myocardial Infarction 122

Myocardial Infarction Chest Pain STEMI Blood Pressure 122

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. So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

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 119

Chest Pain STEMI Ultrasound Heart Attack 119

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. Two stents were placed with resultant TIMI 3 flow.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

OCTOBER 22, 2024

This was sent to me by a French colleague, Olivier Peyronie "Yesterday we received a 62 yo man with diabetes, hypertension and smoker. He reported typical chest pain since 4H AM and arrived at our ED at 10h with ongoing chest pain. You must record frequent serial ECGs for patients with chest pain.

Chest Pain 65

Chest Pain STEMI Myocardial Infarction Angioplasty 65

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

No chest pain. His inpatient clinicians did not think that an urgent angiogram was warranted given that he was chest pain free, his EKG appeared nondiagnostic, and serial troponins were not elevating beyond 2 ug/L. Patients on dialysis often do not have chest pain in the setting of acute MI. Why is this?

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

MIBHS

SEPTEMBER 15, 2024

While men often report crushing chest pain as the most prominent symptom, women might experience subtler symptoms like shortness of breath, nausea, or back pain. Women might describe it as a tightness, pressure, or squeezing sensation rather than a sharp pain.

Blood Pressure 52

Blood Pressure Heart Disease Chest Pain Coronary Artery Bypass Graft 52

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. Women also had more cardiovascular risk factors, including hypertension (66.6%

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

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.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. This was stented. He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal. Most recent echo showed EF of 60%. He had recently had a NonSTEMI.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. or 2) Inferior and lateral OMI that is beginning to reperfuse, even though the patient still has chest pain? He did well.

Chest Pain 109

Chest Pain Ischemia Stents Stent 109

Dr. Smith's ECG Blog

NOVEMBER 8, 2024

Written by Magnus Nossen The below ECG was obtained from a 65 year old man with ongoing chest pain. He has a history of hypertension an d tobacco use. The below ECG was obtained 45 minutes after the first one with the patient being free of chest pain at the time of recording of ECG #2. He is otherwise healthy.

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Chest Pain Myocardial Infarction Hypertension Hospital 100

Dr. Smith's ECG Blog

JANUARY 31, 2025

Written by Magnus Nossen The ECG below was obtained from 50-something male with a history of hypertension and tobacco use. The patient contacted the ambulance service after he experienced sudden onset chest pain and diaphoresis that had started 20 minutes prior. The above ECG is from man in his 80s with crushing chest pain.

STEMI 112

STEMI Chest Pain Myocardial Infarction Ischemia 112

Dr. Smith's ECG Blog

JANUARY 5, 2025

Written by Willy Frick A man in his 60s with hypertension and prior stroke presented with three days of crushing chest pain. He reported intermittent chest pain for the last few months, but never lasting this long. The cardiology consultant notes that pain is "almost resolved." There is active infarction.

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Chest Pain Ischemia Angina Echocardiogram 76

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. After stent placement: The vessel is now open with TIMI 3 flow, although it is diffusely diseased and the middle segment is ectatic.

Chest Pain 67

Chest Pain Stent Stents Risk Factors 67

Dr. Smith's ECG Blog

JANUARY 23, 2025

Case A 76 year old man with chronic hypertension but no history of coronary disease or myocardial infarction presented to the ED with chest pain at 2343. It was treated with a drug eluting stent. It is awaiting FDA approval (but approved for 1.5 The Queen of Hearts recognizes this as OMI ("STEMI/STEMI Equivalent").

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Chest Pain Ischemia STEMI Blog 115

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. He carries the diagnoses hyperlipidemia, hypertension, and diabetes.

STEMI 120

STEMI Chest Pain Myocardial Infarction Aneurysm 120