Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). In any case, the ECG is diagnostic of severe ischemia and probably OMI. All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation.

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Chest Pain Ischemia Pericarditis Tachycardia 106

Dr. Smith's ECG Blog

JUNE 21, 2023

Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. The primary care physician there evaluated this patient and deemed the chest pain to be due to gastrointestinal causes. In this case, the EMS provider was routed to the urgent care facility.

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Chest Pain Cardiac Arrest STEMI Defibrillator 98

Dr. Smith's ECG Blog

AUGUST 11, 2024

Written by Jesse McLaren A healthy 75 year old developed 7/10 chest pain associated with diaphoresis and nausea, which began on exertion but persisted. Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. What do you think?

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Chest Pain STEMI Bradycardia Article 102

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Written by Jesse McLaren Four patients presented with chest pain. Other signs of OMI that complement the ECG include new regional wall motion abnormalities and refractory ischemia References 1. This will make expert OMI interpretation widely available, and help us continue to learn the subtleties of ECG interpretation 4.

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Chest Pain STEMI Electrocardiogram Ischemia 122

Dr. Smith's ECG Blog

JUNE 23, 2024

This was interpreted by the treating clinicians as not showing any evidence of ischemia. He did not remember whether he had experienced any chest pain. He was intubated in the field and sedated upon arrival at the hospital. Here is his presenting ECG: ECG 1, t = 0 What do you think? He was admitted to cardiology.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Stents 121

ECG Cases

DECEMBER 20, 2022

Jesse McLaren discusses some key aspects of cocaine chest pain ECG interpretation in this month's blog including: Patients with cocaine-associated chest pain require benzodiazepines +/- nitroglycerine for symptom relief, aspirin and ECG to look for signs of occlusion and reperfusion.

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Chest Pain STEMI Blog Ischemia 52

DAIC

MAY 2, 2024

a developer of cellular and cell-derived therapeutics for the treatment of cardiovascular and pulmonary diseases, today announced the primary endpoint results of the open label roll-in cohort of the CardiAMP Cell Therapy in Chronic Myocardial Ischemia Trial. Getty Images milla1cf Thu, 05/02/2024 - 10:12 May 2, 2024 — BioCardia, Inc. ,

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Ischemia Angina Heart Failure Outcomes 95

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Another ECG was recorded after the nitroglycerine and now without pain: All findings are resolved. This confirms that the pain was ischemia and is now resovled. The history is concerning ( This patient was awakened from sleep by chest pain that persisted for several hours — on a background of intermittent CP in recent weeks ).

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Ischemia Plaque Stenosis Myocardial Infarction 125

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

A 60-something yo female presented w/ exertional chest pain for 3 days. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. But the patient has active chest pain.

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Chest Pain Echocardiogram Blog Ischemia 81

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.

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Chest Pain Blood Pressure Ischemia STEMI 129

Dr. Smith's ECG Blog

MARCH 1, 2023

Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms. During active chest pain an ECG was recorded: Meyers ECG interpretation: Sinus tachycardia, normal QRS complex, STD in V2-V6, I, II, III and aVF.

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Chest Pain Ischemia Tachycardia Stenosis 52

Dr. Smith's ECG Blog

MAY 29, 2017

Ischemia 3. The ST depression in precordial leads suggest still more widespread ischemia, so the exact culprit is not at all clear. He presented to the ED 1 day later: He stated that he had continued episodes of chest pain and then it became constant that morning (about 8 hours prior). Never assume chest pain is reflux.

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Chest Pain Ischemia Circulation Heart Disease 52

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.

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Chest Pain Ischemia Myocardial Infarction ICU 52

The New England Journal of Medicine

SEPTEMBER 4, 2024

In a 57-year-old man with chest pain, an ECG obtained by EMS showed widespread ST-segment depressions. At the hospital, left main coronary-artery stenosis was seen on angiography (shown in a video).

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Ischemia Chest Pain Stenosis Hospital 62

Dr. Smith's ECG Blog

OCTOBER 15, 2014

A male in his 60's with no history of coronary disease presented with chest pain. I saw this ECG in a stack and noticed that caregivers had been only worried about ischemia. Here is his ED ECG: He had several previous ECGs this year and they were all identical. What do you notice? What should you do? VERY long QT).

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Chest Pain Ischemia 52

Dr. Smith's ECG Blog

MARCH 27, 2023

--The STD in V2-V6 might be interpreted as subendocardial ischemia, but with the inferior STE, it is far more likely to represent posterior OMI. Here is the history: A 40-something male had intermittent chest discomfort until 90 minutes prior to presentation, when it became constant. At 100 minutes, the above ECG was recorded.

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Chest Pain Ischemia Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

Sent by anonymous, written by Pendell Meyers A man in his 60s presented with acute chest pain with diaphoresis. The ECG was incorrectly interpreted as no signs of ischemia. The Importance of the History: As noted above — the onset of chest pain in today's case was acute. His vitals were within normal limits.

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Chest Pain Physiology Stents Blog 52

Dr. Smith's ECG Blog

JANUARY 25, 2024

A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain. As per Dr. Smith, in a patient with new chest pain — these flattened ST segments in leads V2,V3 suggest acute posterior OMI until proven otherwise. Here is his ED ECG: What do you think?

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Chest Pain Stenosis Stents Stent 78

Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. A repeat ECG was recorded with pain 2/10: Not much change.

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Chest Pain STEMI Defibrillator Stents 52

DAIC

MARCH 28, 2024

The study describes the validation of Cleerly's artificial intelligence-guided quantitative coronary CT angiography (AI-QCT) ISCHEMIA technology for diagnostic accuracy and prognostic risk stratification. High Diagnostic Accuracy of AI-ISCHEMIA in Comparison to PET, FFR-CT, SPECT, and Invasive FFR: A Pacific Substudy. 2024.01.007.

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Ischemia Chest Pain Atherosclerosis Coronary Artery Disease 110

ECG Cases

SEPTEMBER 23, 2019

In EM Cases' first ECG Cases blog we review 7 examples of ECGs of patients presenting to the ED with chest pain, who's ECG were read as normal by the computer. And guess what.they all show acute ischemia!

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Ischemia Chest Pain Blog STEMI 52

Dr. Smith's ECG Blog

MAY 23, 2014

This case shows a CT image of subendocardial ischemia. This patient presented with a mechanical fall and had chest pain. His chest pain increased and this ECG was recorded: Now there is increasing inferior ST elevation. Severe Left Main disease, and chest pain with contrast injection into the LM.

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Ischemia Chest Pain STEMI Outpatient 52

Dr. Smith's ECG Blog

JANUARY 25, 2017

A 20-something male drank heavily of ethanol and used cocaine, then was involved in a stressful verbal altercation, at which time he developed chest pain. 911 was called and the medics recorded this ECG (unfortunately, leads V4-V6 are missing) Due to marked ST Elevation, the computer read was STEMI What do you think?

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Chest Pain STEMI Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

JULY 30, 2023

Written by Pendell Meyers A woman in her 50s presented with acute chest pain and lightheadedness since the past several hours. The STD maximal in V1-V4 is diagnostic of acute transmural posterior wall ischemia, most likely due to posterior OMI. Subendocardial ischemia does not localize. AI can do it too.

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Chest Pain Ischemia STEMI Arrhythmia 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." This strongly suggests reperfusing RCA ischemia.

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Dr. Smith's ECG Blog

MAY 6, 2019

The patient presented with chest pain. Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada.

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Chest Pain STEMI Ischemia Myocardial Infarction 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. Is this Acute Ischemia? More on LVH.

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Chest Pain STEMI Blog Stenosis 52

DAIC

MAY 8, 2024

5 Revascularization to improve blood flow to the heart has been shown to reduce mortality in stable chest pain patients. 6 This novel study marks a significant milestone in the field, evaluating the effectiveness of FFR CT in detecting ischemia-producing coronary stenosis in patients with severe PAD. 2024, [link]. 22, 30 Nov.

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Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. He later developed mild continuous chest pain, that he describes as the sensation of someone standing on his chest. They agreed ischemia was likely in the setting of demand given DKA and infection.

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 122

Dr. Smith's ECG Blog

DECEMBER 10, 2019

This is a previously healthy male teenager who was awoken by chest pain. The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain.

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Chest Pain Pericarditis Ischemia Pediatrics 52

Dr. Smith's ECG Blog

JANUARY 2, 2016

A middle aged male presented with chest pain. There may be ischemia present, but it is not evident on the ECG. In LVH, T-wave inversions are usually much more assymetric , like these (Figure 2): Acute Chest pain, but baseline ECG. Here is his ECG ( Figure 1 ): What do you think? All troponins were negative.

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Ischemia Chest Pain STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 22, 2022

Written by Jesse McLaren, with comments from Smith and Grauer A 60 year old presented with three weeks of intermittent non-exertional chest pain without associated symptoms. A prospective validation of the HEART score for chest pain patients at the emergency department. Backus BE, Six AJ, Kelder JC, et al.

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Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

JULY 25, 2024

The ECG shows severe ischemia, possibly posterior OMI. But cardiac arrest is a period of near zero flow in the coronary arteries and causes SEVERE ischemia. It takes time for that ischemia to resolve. Just as important is pretest probability: did the patient report chest pain prior to collapse?

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Cardiac Arrest Ischemia Tachycardia Defibrillator 127

Dr. Smith's ECG Blog

OCTOBER 13, 2022

Written by Jesse McLaren, with edits from Smith and Grauer A 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. 2] Conduction through the accessory pathway can be intermittent (with different degrees of pre-excitation), and affected by ischemia.

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Chest Pain Myocardial Infarction Ischemia STEMI 52

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. Ischemic Hyperacute T waves (Tall, round, symmetric, vs the “pointy” peaked-T’s of HyperK), are often a clue to ischemia. This was written by Sam Ghali ( @ EM_RESUS ), with a few edits by me. This case is tough.

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Chest Pain Aneurysm STEMI Document 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

A 70-year-old man calls 911 after experiencing sudden, severe chest pain. Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. Neth Heart J.

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Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

Written by Jesse McLaren, with edits from Smith A 30 year old with a history of diabetes presented with two days of intermittent chest pain and diaphoresis, which recurred two hours prior to presentation. The chest pain was refractory to nitro so the cath lab was activated: 100% proximal LAD and 99% mid circumflex occlusions.

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Chest Pain STEMI Ischemia Stenosis 52