Dr. Smith's ECG Blog

APRIL 14, 2024

A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike.

Chest Pain 119

Chest Pain Ischemia Myocardial Infarction Ultrasound 119

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The patient continued having chest pain. These diagnoses were not found in his medical records nor even a baseline ECG.

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Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

MARCH 19, 2024

The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. HPI: Abrupt onset of substernal chest pain associated with nausea/vomiting 30 min PTA.

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Chest Pain Myocardial Infarction Stents Stent 111

Dr. Smith's ECG Blog

MARCH 13, 2024

Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It started while he was at rest after finishing a workout.

Chest Pain 108

Chest Pain Angina Echocardiogram Myocardial Infarction 108

Dr. Smith's ECG Blog

APRIL 22, 2024

A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. At times the pain does go to his left neck. It is a ssociated with mild dyspnea on exertion. Am Heart J.

Chest Pain 118

Chest Pain Myocardial Infarction Anatomy Angina 118

Frontiers in Cardiovascular Medicine

APRIL 3, 2025

Despite this, the patient went on to develop chest pain, which was accompanied by electrocardiographic signs of acute extensive anterior wall myocardial infarction and elevated troponin I levels.

COVID-19 52

COVID-19 Chest Pain Myocardial Infarction Laboratory 52

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 ). The ECG is diagnostic of occlusion myocardial infarction (OMI). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. So a patient with high pretest probability (prior CABG with new chest pain), had new ECG changes showing posterior OMI.

Chest Pain 114

Chest Pain STEMI Atrial Flutter Ischemia 114

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

No Chest Pain, but somnolent. The fact that this is syncope makes give it a far lower pretest probability than chest pain, but it was really more than syncope, as the patient actually underwent CPR and had hypotension on arrival of EMS. Here is the ED ECG (a photo of the paper printout) What do you think?

Chest Pain 114

Chest Pain Aneurysm Stents Stent 114

MIBHS

MARCH 31, 2025

A heart attack, or myocardial infarction, happens when an artery becomes blocked, reducing blood flow to the heart muscle. Understanding the difference between heart attack and cardiac arrest can help in recognizing symptoms, seeking prompt medical care, and even saving lives. What is a Heart Attack?

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Chest Pain 52

Open Heart

JUNE 29, 2023

Background Patients who experience acute myocardial infarction (AMI) are at risk of recurrent AMI. Contemporary data on recurrent AMI and its association with return emergency department (ED) visits for chest pain are needed. Return ED visits for chest pain occurred in 27.0% (2017/7467) of index AMI survivors.

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Chest Pain Myocardial Infarction Hospital 52

Dr. Smith's ECG Blog

JUNE 13, 2024

Click here to sign up for Queen of Hearts Access Case A 58-year-old woman presented to the ED with burning chest pain that started 2-3 hours earlier while sitting on a porch swing. In any case, it is diagnostic of OMI in a chest pain patient. But there is also perhaps some STD in inferior leads -- this would support LAD.

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Chest Pain Document STEMI Defibrillator 92

Frontiers in Cardiovascular Medicine

JANUARY 2, 2024

Background Despite the crucial role of Chest pain centers (CPCs) in acute myocardial infarction (AMI) management, China's mortality rate for ST-segment elevation myocardial infarction (STEMI) has remained stagnant.

Chest Pain 59

Chest Pain Myocardial Infarction COVID-19 Catheterization Laboratory 59

Dr. Smith's ECG Blog

JANUARY 31, 2024

A 60-something male presented stating that he had had chest pain that morning which awoke him from sleep but then resolved after several minutes. He has had similar pain in the past which he attributed to acid reflux. He is pain free now. The patient is pain free at the time of this ECG: What do you think?

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Chest Pain Aneurysm Myocardial Infarction Hypertension 109

Dr. Smith's ECG Blog

MAY 23, 2023

Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset.

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Chest Pain STEMI Blog Stent 98

Dr. Smith's ECG Blog

MAY 18, 2011

A 29 year old male presented with 6 hours of stuttering chest pain, constant for the last hour, worse with breathing. Take home point here : Obtain an ECG on anyone with chest pain. Appearance of abnormal Q-waves early in the course of acute myocardial infarction: implications for efficacy of thrmoblytic therapy.

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Chest Pain Myocardial Infarction STEMI Aneurysm 52

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. Literature cited In inferior myocardial infarction, neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction Johanna E. The patient was in clinical shock with a lactate of 8.

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

DECEMBER 29, 2023

Written by Jesse McLaren A previously healthy 50 year-old presented with 24 hours of intermittent exertional chest pain, radiating to the arms and associated with shortness of breath. In a previously healthy patient with new and ongoing chest pain, this is concerning for acute occlusion of the first diagonal artery.

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 70

Frontiers in Cardiovascular Medicine

JANUARY 14, 2024

Background The objective of this study was to investigate the differences in presenting symptoms between patients with and without diabetes being diagnosed with an acute myocardial infarction (AMI). Results Patients with diabetes had significantly less frequent typical pain symptoms, including typical chest pain.

Myocardial Infarction 64

Myocardial Infarction Diabetes Chest Pain Risk Factors 64

Dr. Smith's ECG Blog

JUNE 17, 2018

A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. Inclusion criteria were chest pain, at least 2 serial cTnI in 24 hours, sinus rhythm , and at least 1 ECG.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Frontiers in Cardiovascular Medicine

OCTOBER 8, 2024

ObjectiveAlthough the association between admission glucose (AG) and major adverse cardiac events (MACE) is well-documented, its relationship with 30-day MACE in patients presenting with cardiac chest pain remains unclarified.

Chest Pain 52

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction 52

Heart BMJ

FEBRUARY 23, 2024

For life-threatening events involving complete occlusion of a coronary artery, the activation of ST-elevation myocardial infarction protocols instructs the emergency services to provide immediate treatment and liaise directly with cardiac centres regarding invasive management, in turn, reducing morbidity and saving lives.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Plaque 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Isn't it amazing?? Pol Arch Intern Med. 2017;127:401–411. Circulation.

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Chest Pain STEMI Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

MARCH 13, 2023

A 40-something woman called 911 in the middle of the night for Chest pain that was intermittent. On arrival, she complained of severe pain. The medics had recorded this ECG and were uncertain whether it was recorded during chest pain: Let's get a better image with use of the PM Cardio app : What do you think?

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Chest Pain Myocardial Infarction Angioplasty Thrombosis 52

Dr. Smith's ECG Blog

MARCH 27, 2023

(Unusual and puzzling, as there was a large focal acute MI) Final Diagnosis: Acute MI, Non ST Elevation Myocardial Infarction. The presence or absence of ST Elevation is a poor marker with which to describe a myocardial infarction. = NSTEMI is extremely heterogenous, from a very tiny Non-OMI to a massive OMI.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

A male in late middle age with a history of RCA stent 8 years prior complained of chest pain. See this article by Widimsky: Primary angioplasty in acute myocardial infarction with right bundle branch block: should new onset right bundle branch block be added to future guidelines as an indication for reperfusion therapy [link]

Chest Pain 52

Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

A 70-year-old man calls 911 after experiencing sudden, severe chest pain. Electrocardiographic Manifestations: Acute posterior wall myocardial infarction. Posterior myocardial infarction: the dark side of the moon. This case comes from Sam Ghali ( @EM_RESUS ). Thanks, Sam! J Emerg Med 2001; 20:391-401.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

MARCH 1, 2024

But syncope or seizure alone, without chest pain, is not enough to call it Wellens syndrome. Without chest pain, the pretest probability is not very high. Further review of systems with the patient fully awake revealed that the patient had been having chest pain on and off all week. It can be much lower.

Chest Pain 109

Chest Pain Myocardial Infarction Tachycardia Stenosis 109

Dr. Smith's ECG Blog

JANUARY 6, 2023

Submitted and written by Anonymous, edits by Meyers and Smith A 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache. Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 Abstract 556.

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Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Why is there this notion that myocardial infarction cannot be diagnosed in the setting of ventricular paced rhythm?

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Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

JUNE 17, 2023

Written by Pendell Meyers A middle aged man called EMS for acute chest pain. Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms. EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. I said "Not OMI.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

APRIL 25, 2023

Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. See our publication: ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis There is STE in inferior leads, high lateral leads, and V4-V6. What do you think?

Chest Pain 52

Chest Pain Pericarditis Blog Cardiomyopathy 52

Journal of Cardiothoracic Surgery

JANUARY 6, 2025

Background Diagnosis and prognostic evaluation of acute myocardial infarction (AMI) are crucial for patients. Methods The study subjects were 90 AMI patients and 50 acute chest pain patients (control). All patients were examined by echocardiography and recorded LVEDV, LVESV, and LVEF.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Research 52

Dr. Smith's ECG Blog

OCTOBER 13, 2022

Written by Jesse McLaren, with edits from Smith and Grauer A 60 year old with no past medical history presented with two hours of chest pain radiating to the left arm, with normal vitals. Pseudo ventricular hypertrophy and pseudo myocardial infarction in Wolff-Parkinson-White syndrome. What do you think? Khan and Shaw.

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. Accuracy of OMI findings versus STEMI criteria for diagnosis of acute coronary occlusion myocardial infarction. Who needs the cath lab? Int J Cardiol Heart Vasc 2021 2. Aslanger et al. Lemkes et al.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." References Lobo AS et al. JACC 2019 Sep 10;74(10):1290-1300.

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Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MAY 6, 2019

The patient presented with chest pain. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind.

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Chest Pain STEMI Ischemia Myocardial Infarction 52