Chest Pain Ischemia Nursing 
Dr. Smith's ECG Blog
OCTOBER 24, 2019
[link] A 30 year-old woman was brought to the ED with chest pain. It had started just after nursing her newborn, about an hour prior, and she described it as a severe non-pleuritic “pressure” radiating to the back. She had given birth a week ago, and she had similar chest pain during her labor.
Dr. Smith's ECG Blog
DECEMBER 23, 2014
None of these findings are diagnostic of ischemia, but they should give you a high index of suspicion and prompt serial ECGs at a minimum. The patient was diagnosed with esophageal reflux and was being discharged by the nurse when he had a cardiac arrest. Ischemia comes and goes. The formula results in 23.43, just above the 23.4
Dr. Smith's ECG Blog
MARCH 27, 2025
After only 90 minutes of chest pain, the first troponin was unsurprisingly in the normal range at 11ng/L (normal <26 in males and <16 in females), so the emergency physician waited for repeat troponin. But it was interpreted as no acute ischemia and the patient was referred to cardiology as Non-STEMI. Cardiology aware.
Dr. Smith's ECG Blog
AUGUST 3, 2018
In the evening, a middle-aged man complained of chest pain at the nursing home. Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS. His chest pain was vague. He mentioned "cancer" and "chest". He was awake, with a pulse of 130 and BP of 50/30. Fluids were started.
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.
EMS 12-Lead
JULY 24, 2023
David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. V1 and aVR are often elevated in subendocardial ischemia.
EMS 12-Lead
MAY 20, 2022
David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review and commentary by Dr. Steve Smith [link] @SmithECGblog It is early-summer, approximately 1330 hours, no cloud cover overhead, and 86 degrees with high humidity. A 59 y/o Female calls 911 for crushing chest discomfort and difficulty breathing.
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