Chest Pain, Ischemia and Pericarditis

Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Dr. Smith's ECG Blog

MAY 27, 2024

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? Kontos et al. J Am Coll Cardiol 2022 4.

Chest Pain

Chest Pain STEMI Myocardial Infarction Ischemia

ECG Blog #448 — A Young Man with Chest Pain.

Ken Grauer, MD

SEPTEMBER 21, 2024

For example, considering whatever symptoms that the patient may have had ( ie, chest pain, palpitations, shortness of breath, etc. ) — what this might mean in view of the ECG we are looking at. STEP #2 = Clinical Impression — in which we correlate our assessment that we made in Step #1 to the clinical situation at hand.

Chest Pain

Chest Pain Blog Thrombosis Risk Factors

A 29 year old male with chest pain, ST Elevation, and very elevated troponin T

Dr. Smith's ECG Blog

APRIL 9, 2024

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. It is easy to say pericarditis in such a case.

Chest Pain

Chest Pain Pericarditis Blog Risk Factors

Three prehospital ECGs in patients with chest pain

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. Nossen Comment/Interpretation: Evaluation of ischemia on an ECG can be very challenging.

Chest Pain

Chest Pain Ischemia Pericarditis Tachycardia

What does this ECG show?

Dr. Smith's ECG Blog

AUGUST 4, 2024

Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. Pericarditis maybe." Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. Meyers' words — "is one of the rare ECGs that is actually specific for pericarditis".

Pericarditis

Pericarditis Chest Pain Blog Aortic

Why the sudden shock after a few days of malaise?

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). As already mentioned, this patient could have post-infarction regional pericarditis from a large completed MI. Sinus tachycardia has many potential causes. Hammill SC.

Cardiogenic Shock

Cardiogenic Shock Pericarditis Chest Pain Myocardial Infarction

Teenager with chest pain and slightly elevated troponin. What happens then?

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.

Chest Pain

Chest Pain Pericarditis Ischemia Pediatrics

Pericarditis, or Anterior STEMI? The QRS proves it.

Dr. Smith's ECG Blog

AUGUST 24, 2012

A young otherwise healthy man presented with 4 hours of sharp 10/10 substernal chest pain. But there was some doubt as to whether it might be pericarditis because of the ST elevation in I and II, without ST depression in III. This is a good sign for myocardial infarction and does not happen in pericarditis. BP was 160.

Pericarditis

Pericarditis STEMI Chest Pain Myocardial Infarction

You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

Dr. Smith's ECG Blog

JUNE 20, 2018

A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to "both axilla" as well as the upper back. She was reportedly "pacing in her room while holding her chest". Clinician and EKG machine read of acute pericarditis.

Pericarditis

Pericarditis Chest Pain Blog Ultrasound

A man in his 50s with shortness of breath

Dr. Smith's ECG Blog

MARCH 26, 2024

There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Aslanger's is a combination of acute inferior OMI plus subendocardial ischemia, and due to the ischemia vectors , it has STE only in lead III. Moreover, there is tachycardia.

Chest Pain

Chest Pain Embolism Pulmonary Ischemia

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

A woman in her 70s with chest pain

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Ischemic ST depression includes posterior OMI and subendocardial ischemia.

Chest Pain

Chest Pain Ischemia Aortic Aortic valve

Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

2 days later This is a typical LVH pattern, without ischemia Patient underwent 4 vessel CABG. Upon questioning patient, he denies having any chest pain or chest tightness of any sort. Pericarditis would be even more unlikely in someone without chest pain. Chest pain is squeezing or tight in nature.

Chest Pain

Chest Pain Coronary Artery Bypass Graft Pericarditis Blog

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. True Positive ECG#2 : Also sinus rhythm.

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

Dr. Smith's ECG Blog

JUNE 18, 2011

3 hours prior to calling 911 he developed typical chest pain. This rules out pericarditis, which essentially never has reciprocal ST depression. When flow is restored, wall motion may completely recover so that echocardiogram does not detect the previous ischemia. This is not pericarditis because: a.

STEMI

STEMI Pericarditis Hospital Aneurysm

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Thus, this apparently is Aslanger's Pattern (inferior OMI with single lead STE in lead III, with simultaneous subendocardial ischemia).

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Chest trauma was suspected on initial exam. The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma? ST depression. Myocardial Contusion?

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??

Dr. Smith's ECG Blog

JANUARY 28, 2018

More Smith comment: it is true that ST depression (STD) due to subendocardial ischemia does not localize [it is usually diffuse ST depression, in multiple leads and not reciprocal to ST elevation in an opposite territory], this ST depression is different! Notice how useful serial ECGs are! mm ST depression in aVL. mm ST depression in aVL.

Pericarditis

Pericarditis Ischemia STEMI Chest Pain

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

Dr. Smith's ECG Blog

MARCH 11, 2019

You do NOT see this in normal variant STE, nor in pericarditis. 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." Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI.

Chest Pain

Chest Pain Ischemia Aneurysm Myocardial Infarction

A middle aged female with "heartburn" and a "normal ECG" per the computer

Dr. Smith's ECG Blog

AUGUST 8, 2020

Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? Weren't you taught that "new tall T wave in V1" is concerning for ischemia, and so this is the opposite? Expert ECG interpretation can often distinguish normal variant STE from OMI from pericarditis.

Pericarditis

Pericarditis STEMI Chest Pain Arrhythmia

Nausea and Vomiting. This ECG is loaded with information.

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

He denied fevers and chills, abdominal pain, chest pain, or SOB. Normal RBBB, no evidence of ischemia. Patients with completed, transmural infarct are also at risk for post-infarction regional pericarditis and myocardial rupture. Patient stated his dry weight is around 85 kg. He did have one episode of diarrhea.

Aneurysm

Aneurysm Ischemia Embolism STEMI

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. Myocardial Rupture and Postinfarction Pericarditis.

Myocardial Infarction

Myocardial Infarction Pericarditis Angina STEMI

Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

Dr. Smith's ECG Blog

JUNE 28, 2019

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. Pericarditis? A straight ST segment virtually never happens in inferior ST elevation that is NOT due to OMI (normal variant, pericarditis) 4. More likely, these T waves probably reflect ischemia of uncertain age.

Chest Pain

Chest Pain Pericarditis Stent Stents

A woman in her 20s with syncope

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia.

Pericarditis

Pericarditis Tachycardia Ultrasound Blood Pressure

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. ST depression. Myocardial Contusion?

Arrhythmia

Arrhythmia Blog Chest Pain Cardiac Arrest

A woman in her 40s with acute chest pain and shortness of breath

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation.

Chest Pain

Chest Pain Embolism Pulmonary Tachycardia

Cardiovascular Update

Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

ECG Blog #448 — A Young Man with Chest Pain.

A 29 year old male with chest pain, ST Elevation, and very elevated troponin T

Three prehospital ECGs in patients with chest pain

What does this ECG show?

Why the sudden shock after a few days of malaise?

Teenager with chest pain and slightly elevated troponin. What happens then?

Pericarditis, or Anterior STEMI? The QRS proves it.

You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

A man in his 50s with shortness of breath

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

A woman in her 70s with chest pain

Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.

Should we activate the cath lab? A Quiz on 5 Cases.

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

A teenager involved in a motor vehicle collision with abnormal ECG

Is this ECG diagnostic of coronary occlusion? Also: Inferior de Winter's T-waves on prehospital ECG??

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

A middle aged female with "heartburn" and a "normal ECG" per the computer

Nausea and Vomiting. This ECG is loaded with information.

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Inferior Subtle ST elevation: straight ST segment, but also no reciprocal ST depression in aVL: which is more important?

A woman in her 20s with syncope

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

A woman in her 40s with acute chest pain and shortness of breath

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