Dr. Smith's ECG Blog

OCTOBER 2, 2021

Submitted by Benjamin Garbus, MD with edits by Bracey, Meyers, and Smith A man in his early 30s presented to the ED with chest pain described as an “explosion" of left chest pressure. Pain largely resolved prior to EMS arrival but completely subsided after prehospital NTG and aspirin. Triage EKG: What do you think?

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Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 31, 2013

A 20-something male presented from an outside facility with Chest pain. No thromboembolism risks, not pleuritic, no radiation to the back. No cardiac risk factors, no cocaine use. T-wave inversion in V2 is inconsistent with early repol, and is typical of posterior ischemia. Vital signs were normal.

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Chest Pain Aneurysm STEMI Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast. The patient was given opiates which improved his chest pain to 7/10. The consulting cardiologist wrote in their note: “Could be cardiac chest pain. She is usually incredibly good at recognizing them!

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Chest Pain Blog Hospital Tachycardia 116

Dr. Smith's ECG Blog

SEPTEMBER 6, 2011

A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure. Thus, there are some suspicious abnormalities, but no definite signs of ischemia. The difference is significant and highly suggests posterior ischemia. He was diaphoretic. It is very subtle but real.

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Chest Pain Ischemia STEMI Stents 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.

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STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Anish Koka

MAY 16, 2023

This means that at every age, the probability a man complaining of chest pain has significant underlying coronary disease as a cause of this chest pain is much higher than a woman complaining of chest pain. Women also had more cardiovascular risk factors, including hypertension (66.6%

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

APRIL 2, 2014

A male in his 60's called 911 for chest pain. He had some cardiac risk factors including hypertension, on meds, but no previous coronary disease. His pain was intermittent and he was vague about when it was present and when it was resolved. Is it subendocardial ischemia, or inferior MI?

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STEMI Ischemia Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

JULY 22, 2023

He denied chest pain or shortness of breath. In the clinical context of weakness and fever, without chest pain or shortness of breath, the likelihood of Brugada pattern is obviously much higher. Today's patient presented with acute weakness, syncope and fever, but no chest pain or shortness of breath.

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 74

Dr. Smith's ECG Blog

NOVEMBER 17, 2014

This case was recently posted by Tyron Maartens on Facebook EKG club (he agreed to let me post it here), with the following clinical information: "42 year old male with two weeks of intermittent chest discomfort, awoke 4 hours prior to this ECG with a more severe, heavy chest pain (5/10). BP 112/80, SpO2 100%.

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Aneurysm STEMI Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

AUGUST 26, 2019

She did not report any chest pain or pressure. She was brought to the Emergency Department and this ECG was recorded while she was still feeling nauseous but denied chest pain, shortness of breath, or other symptoms: What do you think? The morphology of STE is not diagnostic of being due to acute transmural ischemia.

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Chest Pain STEMI Biomarkers Article 52

EMS 12-Lead

JULY 24, 2023

But the symptoms returned with similar pattern – provoked by exertion, and alleviated with rest; except that on each occasion the chest pain was a little more intense, and the needed recovery period was longer in duration. It should be known that each category can easily manifest the generic subendocardial ischemia pattern.

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Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

AUGUST 15, 2019

Written by Pendell Meyers A male in his early 50s presented with waxing and waning chest pain starting at rest. He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS. Here is his initial ECG: What do you think? mm of the "required" 1.0 Repeat ECGs are almost always helpful.

STEMI 52

STEMI Chest Pain Risk Factors Anatomy 52

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.

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Coronary Angiogram Plaque Thrombosis STEMI 108

Dr. Smith's ECG Blog

JULY 31, 2018

hours of substernal chest pressure. She had zero CAD risk factors. 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.

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SCAD Chest Pain Myocardial Infarction Ischemia 52

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.

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Aortic valve Myocardial Infarction Aortic Blood Pressure 103

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.

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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?

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Stents Stent Heart Attack Heart attacks 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The patient contacted EMS after a few hours of chest pain that started 5:30 AM. The pain was described as 6/10 radiating to the right shoulder. The chest pain was described as both sharp and pressure like. There is slight ST depression in lateral chest leads V4,V5,V6 — but I thought this to be nonspecific.

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Chest Pain Blog Risk Factors Ischemia 63

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". The source of this case is anonymous.

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Pericarditis Chest Pain Blog Ultrasound 52

Dr. Smith's ECG Blog

MARCH 20, 2023

Case "Male, 43yo, come to ED with Epigastric Pain started 3 hours ago. Risk Factors: High Cholesterol. Smith and Meyers have emphasized on many occasions — ST depression that is maximal between leads V2-to-V4 in a patient with new chest pain should be assumed to be posterior OMI until proven otherwise.

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Chest Pain STEMI Blog Cholesterol 52

Dr. Smith's ECG Blog

AUGUST 9, 2018

Denied headache, chest pain, nausea / vomiting. No history, meds, or risk factors. If this patient had chest pain and the value suggested early repol, I would be very hesitant to act on it. They gave him water with salt, as he thought he was dehydrated." Ambulated to ambulance for eval. Wang, page 171).

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STEMI Chest Pain RN Anatomy 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Case A 39-year-old male without prior medical history presents with chest pain that started 2 hours prior to presentation. He says that the pain intensity was 10/10 at home but now about 4/10. He has no cardiovascular risk factors except smoking for 10 pack-years. Here are his publications.) His ECG is shown below.

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Myocardial Infarction Chest Pain Blog Echocardiogram 40

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.

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Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. or 2) Inferior and lateral OMI that is beginning to reperfuse, even though the patient still has chest pain? ECG 1 What do you think?

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Chest Pain Ischemia Stents Stent 99