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.

STEMI 52

STEMI Chest Pain Pericarditis Ischemia 52

DAIC

MAY 14, 2024

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death.

Coronary Artery Disease 111

Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

CardiacWire

APRIL 24, 2024

Because of the clinical and medicolegal consequences of incorrectly discharging an MI patient, medical practices and clinical research have largely focused on addressing MI underdiagnosis. One study revealed that a quarter of all ED visitors underwent a troponin test, even though less than half of them had chest pain.

Myocardial Infarction 59

Myocardial Infarction Chest Pain Biomarkers Ischemia 59

DAIC

FEBRUARY 29, 2024

Five highly-anticipated late-breaking clinical trial sessions, an ACC/AHA guidelines update session and a host of featured clinical research sessions have been announced by program planners for the American College of Cardiology’s 73 rd Annual Scientific Session & Expo to be held April 6-8 in Atlanta, GA.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

JUNE 1, 2022

A 40-something male with no previous cardiac disease presented with chest pain. Here is his ECG: There is no clear evidence of OMI or ischemia. Moreover, the research which appears to confirm this idea was indeed in relation to the circumflex, but they did not study Occlusion ; rather, they studied asymptomatic coronary disease.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Bradycardia 52

Dr. Paddy Barrett

AUGUST 1, 2023

Share Chest Pain Symptoms There is no role for CT Calcium Scoring in the setting of someone with chest pain symptoms suspected to be from a narrowed coronary artery. Regardless, if you present with chest pain and get a stress test instead of a CTCA, you are arguably getting an inferior test. I would say yes.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Paddy Barrett

NOVEMBER 28, 2023

Ischemia Trial In an attempt to clarify this question, a similar trial was done called the Ischemia Trial, which had important differences to the Courage trial but again tried to answer a similar question 3. But what about those with symptoms such as chest pain or shortness of breath as a result of their coronary artery disease?

Stents 53

Stents Stent Heart attacks Heart Attack 53

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

JULY 31, 2018

About this time, the 4th troponin, drawn at 8 hours after onset of pain, peaked at 20.956 ng/mL. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. She has done quite a bit of research on the topic.

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Case An elderly patient had acute chest pain and 911 was called. And, in cases like the elderly patient with new-onset chest pain presented here — definitive diagnosis of acute STEMI is sometimes deceptively easy. It is important for cardiologists to realize that a paramedic may see something they do not.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain. A mid 60s woman with history of hypertension, hyperlipidemia, and GERD called 911 for chest pain. It is also NOT the clinical scenario of takotsubo (a week of intermittent chest pain).

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Paddy Barrett

DECEMBER 5, 2023

Whether stenting a narrowed coronary artery improves symptoms such as chest pain (angina) or shortness of breath is a very different question. Subscribe now 1 ISCHEMIA Research Group. However, the devil is in the detail when considering this question, and I have discussed it in more detail here. What About Symptoms?

Stents 59

Stents Stent Angina Heart Attack 59

Dr. Smith's ECG Blog

DECEMBER 27, 2018

I do research on Cardiologs' algorithm: Smith SW et al. But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. All bets would be off if instead of no chest pain, this patient had worrisome new-onset symptoms. The Ratios of STE to S-wave: V1: 2.5/16

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. It was from a patient with chest pain: Note the obvious Brugada pattern. This was submitted by Alexandra Schick. Dr. Schick is a PGY3 at the Brown Emergency Medicine Residency in Rhode Island. The article is edited by Smith.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. See this other post: Chest pain, a ‘normal ECG’ a ‘normal trop’, and low HEART and EDACS score: discharge home? Below is the ECG.

Chest Pain 52

Chest Pain STEMI Bradycardia Ischemia 52

Cardiometabolic Health Congress

MAY 10, 2024

In a study published by the American Heart Association, “Sex and Age Differences in the Association of Depression With Obstructive Coronary Artery Disease and Adverse Cardiovascular Events,” researchers investigated 3,237 patients (35% women) undergoing coronary angiography to evaluate for coronary artery disease (CAD).

Coronary Artery Disease 59

Coronary Artery Disease Obesity Chest Pain Ischemia 59

Ken Grauer, MD

OCTOBER 4, 2024

As to ST-T wave changes in the 12-lead ECG — although some leads show T wave inversion (ie, in leads III, V3 and V4 ) — I did not think this looked acute in this 30-year old man without chest pain. No evidence of ischemia. Figure-2: I’ve labeled atrial activity from Figure-1 with colored arrows. What about the Repeat ECG?

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Blog Bradycardia Arrhythmia Pacemaker 103

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Evidence of acute ischemia (may be subtle) vii. Left BBB vi. Pathologic Q-waves viii.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

CardiacWire

JANUARY 10, 2025

SPECT continues to be a first-line test to diagnose coronary ischemia, often instead of or before invasive coronary angiography. To determine if AI-CCTA could hold its own, researchers analyzed CCTA images from 175 patients using Cleerlys AI-QCT ISCHEMIA model and found it outperformed SPECT when compared to invasive angiography.

Coronary Artery Disease 59

Coronary Artery Disease Ischemia Chest Pain Reimbursement 59

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. link] Bentzon, J.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75