Chest Pain ICU Ischemia 
Dr. Smith's ECG Blog
JUNE 23, 2024
This was interpreted by the treating clinicians as not showing any evidence of ischemia. 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. Two subsequent troponins were down trending.
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 Abstract 556.
Dr. Smith's ECG Blog
OCTOBER 25, 2023
He did not have chest pain. A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." Chest pain in high risk patient. Is it STEMI?
Dr. Smith's ECG Blog
JANUARY 9, 2024
Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Do you agree with this strategy?
Dr. Smith's ECG Blog
MARCH 11, 2019
The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." The patient was managed in the ICU and had serial troponins. Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI. First was 2.9
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. Back to the case: The providers recognized persistent ischemia and likely occlusion, and discussed this with cardiology who took the patient immediately for cath. They opened it.
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.
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