Chest Pain Ischemia Pacemaker 
Dr. Smith's ECG Blog
MARCH 22, 2024
Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible.
Dr. Smith's ECG Blog
NOVEMBER 5, 2023
She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. Many health care providers will simply not attempt to assess ischemia in the presence of a wide QRS.
Dr. Smith's ECG Blog
SEPTEMBER 30, 2019
Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.
Dr. Smith's ECG Blog
JANUARY 9, 2024
She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. She presented to the emergency department after a couple of days of chest discomfort. Are you confident there is no ischemia? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)?
Ken Grauer, MD
OCTOBER 13, 2023
She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. Is a pacemaker needed? The ECG in Figure-1 was obtained from a woman in her 60s — who was seen in the ED ( E mergency D epartment ) as part of her evaluation for trauma following a motor vehicle accident. Is this " high -grade" AV block?
Dr. Smith's ECG Blog
JANUARY 1, 2024
Although the patient reported experiencing mild pressure-like chest pain, there was suspicion among clinicians that this might be indicative of an older change. Again, see Ken's discussion below) Discussion continued The absence of pace spikes suggests this is not a pacemaker/ICD-related rhythm in this patient with an ICD.
Ken Grauer, MD
OCTOBER 27, 2023
My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. This suggests ischemia of uncertain duration. A permanent pacemaker was placed. PEARL # 2: Interpretation of the 12-lead ECG in Figure-1 is no easy task!
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