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

MARCH 26, 2024

Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. Moreover, there is tachycardia.

Chest Pain 68

Chest Pain Embolism Pulmonary Ischemia 68

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

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath. It shows sinus tachycardia with right bundle branch block. Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock).

Cardiogenic Shock 126

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 126

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

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 114

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 114

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. Multifocal Atrial Tachycardia 2. P EARL # 4 — In “real life” — there is often NO distinct “cut-off” for differentiating between sinus tachycardia with multiple different-looking PACs vs MAT. Here is the ECG: What do you think?

Atrial Fibrillation 52

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. There is some ST-segment elevation in DII, DIII, aVF, V4-6. What is the rhythm?

Tachycardia 111

Tachycardia Blog Heart Failure Ischemia 111

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? In addition to sinus tachycardia, the only abnormalities listed by the computer were "low voltage, precordial leads" and "anteroseptal infarct, old.Q Physician: "No STEMI."

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Ken Grauer, MD

MARCH 27, 2024

No chest pain. In the context of today's case — these P waves are diagnostic of RAE = P Pulmonale ( See ECG Blog #75 ) and almost certain associated pulmonary hypertension. Retrospectively — I interpret this 1:1 retrograde conduction as diagnostic of a reentry SVT rhythm as the etiology of the initial tachycardia.

Blog 186

Blog Congenital Heart Disease Congenital Heart Disease 186

Dr. Smith's ECG Blog

MARCH 12, 2018

This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Wellens' is a syndrome of a painless period following an anginal (chest pain) event. Chest pain, SOB, Precordial T-wave inversions, and positive troponin.

Chest Pain 40

Chest Pain Pulmonary Embolism Tachycardia 40

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

My answer: "This is classic for PE, but it can also be present in any hypoxia due pulmonary hypoxic vasoconstriction and resulting acute pulmonary hypertension and acute right heart strain. Tachycardia (or nearly) 2. Tachycardia, = 1.8. An ECG was texted to me (Smith) without any clinical information: What did I say?

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

JULY 1, 2019

Case 2: sent by Dr. James Alva A man in his 50s with diabetes, hypertension, and hyperlipidemia presented to the ED with chest pain and shortness of breath off and on over the past three days, with associated vomiting. The rhythm is sinus tachycardia at ~105/minute. The rhythm is sinus tachycardia at ~115/minute.

Chest Pain 52

Chest Pain Ischemia STEMI Blog 52

Ken Grauer, MD

FEBRUARY 13, 2023

The ECG in Figure-1 was obtained from an older woman — who presented with chest pain and palpitations over the previous hour. She had a history of hypertension, and was on medication for this — but she was otherwise healthy. BP = 140/90 mm Hg in association with the rhythm in Figure-1. Is this Ventricular Bigeminy?

Blog 78

Blog Arrhythmia Exercise Chest Pain 78

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. A normal PR interval.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

EMS 12-Lead

JULY 24, 2023

But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chest pain was a little more intense, and the needed recovery period was longer in duration. Severe Tachycardia Acute Coronary Syndrome (obstructive coronary disease) a. This results in Type I MI.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

MARCH 2, 2019

Palpitations in a Young Healthy Male A pathognomonic ECG you should recognize instantly A middle-aged man with severe syncope, diffuse weakness Chest pain and Diffuse ST depression, with STE in aVR. Does this patient have hypertension and/or heart failure that has worsened? You probably think it is left main.

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Frontiers in Cardiovascular Medicine

FEBRUARY 24, 2025

This results in severe chest pain or discomfort, with the subsequent release of cardiac biomarkers, and alterations in the electrocardiogram. Hypertension and diabetes were the two most common risk factors identified. It can cause diminished heart function and mortality if not treated properly with suitable measures.

Hospital 98

Hospital Myocardial Infarction Chest Pain Electrocardiogram 98

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. This was contributed by some folks at Wake Forest: Jason Stopyra, Shannon Mumma, Sean O'Rourke, and Brian Hiestand.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

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 138

Chest Pain Embolism Pulmonary Tachycardia 138

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. He woke up alert and with chest pain which he also had experienced intermittently over the previous few days. The syncope lasted about 2-3 minutes according to his wife.

Cardiogenic Shock 127

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 127

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. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? Now another, with ultrasound.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

BoardVitals - Cardiovascular

JANUARY 18, 2021

ACS QID 3103 A 64 year old Caucasian male with a history of extensive tobacco use, hypertension, hyperlipidemia, and obesity presents with acute onset chest pain. His exam was notable for tachycardia, elevated jugular venous pressure, diffuse rales, and an early 2/6 systolic murmur loudest at the cardiac apex. Question 2.

Bicuspid/Mitral 52

Bicuspid/Mitral Atrial Fibrillation Chest Pain STEMI 52

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. See here for management of Polymorphic Ventricular Tachycardia , which includes Torsades. In multivariate analysis, serum potassium level was negatively and age positively related to ventricular tachycardia. Most recent echo showed EF of 60%.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 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.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

JANUARY 24, 2025

Written by Willy Frick A 52 year old man with hypertension, dyslipidemia, and seropositive rheumatoid arthritis (a risk factor for CAD) presented with acute substernal chest pressure with diaphoresis which woke him from sleep just after midnight. Ventricular tachycardia?) Improved chest pain is unresolved chest pain.

Chest Pain 123

Chest Pain STEMI Risk Factors Coronary Artery Disease 123

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Case 1: 20-something woman with chest pain Case 2: 50-something man with chest pain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chest pain. History Patient complains of a 24-hours of chest pain of sudden onset, sharp in nature. Denies SOB.

Chest Pain 104

Chest Pain Aortic STEMI Ultrasound 104

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.

Chest Pain 100

Chest Pain Myocardial Infarction Hypertension Hospital 100

Dr. Smith's ECG Blog

JANUARY 21, 2025

He denied chest pain. A Chest X-ray did not show pulmonary edema. This ECG was recorded: It is difficult to appreciate P-waves, but I believe this is sinus tachycardia. It is correct that he did not have chest pain, but we must remember that fully 1/3 of full blown STEMI do not present with chest pain.

Chest Pain 61

Chest Pain STEMI Tachycardia Myocardial Infarction 61

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. 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 111

Chest Pain Embolism Pulmonary Tachycardia 111

Dr. Smith's ECG Blog

APRIL 18, 2025

Written by Hans Helseth, with edits and comments by Smith and Grauer An 84 year old man with chronic hypertension and CKD presented to a primary care clinic. He played a round of golf a week prior and felt an episode of chest pain during the round, which spontaneously resolved. Does this patient have ACS Symptoms?

Chest Pain 80

Chest Pain Cardiac Arrest Tachycardia ICU 80