Chest Pain and ICU - Cardiovascular Update

VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

JUNE 23, 2024

Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. He did not remember whether he had experienced any chest pain. (TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Two subsequent troponins were down trending.

Chest Pain

Chest Pain Cardiac Arrest Sudden Cardiac Death Stents

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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

Chest Pain Embolism Pulmonary Tachycardia

A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

JANUARY 6, 2023

Submitted and written by Anonymous, edits by Meyers and Smith A 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache. Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6

Chest Pain

Chest Pain Ischemia Myocardial Infarction ICU

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms.

Pericarditis

Pericarditis Chest Pain Aortic Blog

A Patient with Respiratory Failure and a Computer "Normal" ECG

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. At some point he returned with chest pain, and all these findings were put into place. Many MI do not have chest pain 4. It is worthwhile keeping in mind important findings from this study: More than 1/4 of all MIs are not accompanied by chest pain.

Chest Pain

Chest Pain Ischemia Aneurysm Myocardial Infarction

I'm so sorry when medics get abused for activating the cath lab

Dr. Smith's ECG Blog

OCTOBER 28, 2022

He went into cardiogenic shock and is intubated in the cardiac ICU. I just got the follow up that he had a near complete very proximal LAD occlusion , and a complete PDA occlusion. Not the culprit artery I was expecting but potentially a wraparound LAD?

Chest Pain

Chest Pain Myocardial Infarction Pacemaker Cardiogenic Shock

OMI Can be Diagnosed by "Pseudonormalization of ST Segments"

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. While she was in her bed at home, she had sudden onset of left sided chest pain that radiated to her shoulder. The pain was pleuritic, without nausea or diaphoresis.

Chest Pain

Chest Pain Ultrasound Risk Factors Diabetes

A crashing patient with an abnormal ECG that you must recognize

Dr. Smith's ECG Blog

MARCH 12, 2018

Wellens' is a syndrome of a painless period following an anginal (chest pain) event. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. She also complained of generalized weakness, lightheadedness, diaphoresis, chest pain, and cough. What is the Diagnosis? She was discharged and did well.

Chest Pain

Chest Pain Pulmonary Embolism Tachycardia

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

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

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia

The latest CDC paper on vaccine myocarditis is NOT reassuring

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. The CDC study published in Lancet on previously healthy 12-29 years old’s is a survey-based study.

COVID-19

COVID-19 Hospital Chest Pain Quality of Life

Could you have prevented this young man's cardiac arrest?

Dr. Smith's ECG Blog

JULY 24, 2018

Upon arrival in the ICU, before getting Continuous Veno-Venous Hemodialysis (CVVHD), his potassium had risen again to 7.8 Given the absence of chest pain — cardiac contusion is also unlikely. At that time his diastolic blood pressure was also hovering between 45 and 55 mmHg. There is no ECG available from this time.

Cardiac Arrest

Cardiac Arrest Chest Pain Tachycardia ICU

A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

OCTOBER 25, 2023

He did not have chest pain. The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Chest pain in high risk patient. Here is his triage ECG: What do you think? See these other relevant cases: What are these bizarre bigeminal PVCs?? Is it STEMI?

Ischemia

Ischemia Chest Pain Cardiac Arrest Blog

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath. E CG # 1 was obtained in the referral hospital, approximately 2 hours after the onset of chest pain. This ECG was recorded on arrival: What do you think?

STEMI

STEMI Chest Pain Myocardial Infarction Ischemia

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

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

Chest Pain Bradycardia Cardiac Arrest STEMI

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

Dr. Smith's ECG Blog

OCTOBER 26, 2011

This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.

STEMI

STEMI Myocardial Infarction Chest Pain Angioplasty

20-something with huge verapamil overdose and cardiogenic shock

Dr. Smith's ECG Blog

MAY 26, 2023

And she does not know that this is an overdose; she thinks it is a patient with chest pain!! He was admitted to the ICU and was unstable, in shock, overnight. Case Continued: He was stabilized on more calcium, pressors, and high dose insulin. 3 hours later, this was recorded at a K of 2.8 mEq/L and total calcium of 14.7

Cardiogenic Shock

Cardiogenic Shock Arrhythmia Blog Education

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

JANUARY 9, 2024

The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. A bed side echocardiography revealed a severely depressed LVEF of about 20-25%. When looking at the above ECG you will find that the QRS following ventricular pacing is very long.

Tachycardia

Tachycardia Electrophysiology Atrial Flutter Ischemia

VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

A woman in her 50s with acute chest pain

"Pericarditis" strikes again

A Patient with Respiratory Failure and a Computer "Normal" ECG

I'm so sorry when medics get abused for activating the cath lab

OMI Can be Diagnosed by "Pseudonormalization of ST Segments"

A crashing patient with an abnormal ECG that you must recognize

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

The latest CDC paper on vaccine myocarditis is NOT reassuring

Could you have prevented this young man's cardiac arrest?

A man in his 60s with syncope and ST depression. What does the ECG mean?

What will you do for this patient transferred to you who is now asymptomatic?

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

20-something with huge verapamil overdose and cardiogenic shock

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

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