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.

Chest Pain 98

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. 3) Q-waves are independently associated with worse outcomes (78% relative increase in 90-day mortality in Armstrong et al.)

Chest Pain 52

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

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?? hours earlier? Pol Arch Intern Med. 2017;127:401–411.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 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

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.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Journal of the American Heart Association

MARCH 27, 2025

BackgroundRecent evidence highlights an increasing incidence of myocardial infarction in young women. years]) admitted to the China Chest Pain Center Database between 2016 and 2021. years]) admitted to the China Chest Pain Center Database between 2016 and 2021.

Myocardial Infarction 40

Myocardial Infarction Peripheral Arterial Disease Outcomes Chest Pain 40

Journal of the American Heart Association

APRIL 16, 2025

BackgroundHighsensitivity cardiac troponin (hscTnI) assays can quantify troponin concentrations with low limits of detection, potentially expediting and enhancing myocardial infarction diagnoses. The primary outcome was hospital length of stay. Journal of the American Heart Association, Ahead of Print.

Chest Pain 40

Chest Pain Myocardial Infarction Hospital Outcomes 40

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." Lobo et al. examined SCAD presenting as STEMI (unlike Hassan et al.

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

JUNE 28, 2018

He had suffered a couple bouts of typical chest pain in the last 24 hours. This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. The pain had lasted about one hour. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction.

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Chest Pain Myocardial Infarction STEMI Article 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin. J Am Heart Assoc.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

AUGUST 19, 2023

Because the patient had no chest pain or shortness of breath, they were initially diagnosed as gastroenteritis. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Circulation: Cardiovascular Quality & Outcomes

MAY 23, 2024

Circulation: Cardiovascular Quality and Outcomes, Ahead of Print.

Chest Pain 40

Chest Pain Myocardial Infarction Circulation Outcomes 40

Dr. Smith's ECG Blog

DECEMBER 16, 2019

This case was texted to me by one of our residency graduates, and with the outcome, so I don't know how I would have interpreted it blindly. A 50-something male who is healthy and active with no previous medical history presented with 5 hours of continuous worrisome chest pain. The highest ST/S ratio is in V3, and is 2.5/13

Chest Pain 52

Chest Pain Myocardial Infarction Stent Stents 52

Circulation: Cardiovascular Imaging

NOVEMBER 20, 2023

Risk ratios (RRs) and mean differences with 95% CIs were computed for binary and continuous outcomes, respectively.RESULTS:Five randomized controlled trials with a total of 5727 patients were included, of whom 51.1% 1.10];P=0.198), nonfatal myocardial infarction (RR, 1.09 [95% CI, 0.63–1.88];P=0.768),

Chest Pain 40

Chest Pain Myocardial Infarction Cardiovascular Imaging Ischemia 40

Dr. Smith's ECG Blog

APRIL 8, 2022

There is a patient with persistent chest pain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chest pain patient. Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients.

Chest Pain 52

Chest Pain SCAD STEMI Blog 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.

Chest Pain 130

Chest Pain Myocardial Infarction Blog Stent 130

Coronary Artery Disease Journal

NOVEMBER 25, 2024

How frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical.

Chest Pain 40

Chest Pain Myocardial Infarction Outcomes Heart Failure 40

Dr. Smith's ECG Blog

MAY 31, 2023

A 67 yo f developed chest pain this morning." Opiates are associated with worse outcomes in Myocardial Infarction. See this case: A man his 50s with chest pain. Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative.

STEMI 96

STEMI Chest Pain Myocardial Infarction Ischemia 96

DAIC

FEBRUARY 29, 2024

This year’s theme, “Advancing Cardiovascular Care for All” brings the latest practice-changing breakthroughs, along with top experts debating and discussing outcomes of highly-anticipated clinical trials. 24 from April 6 - 8, 2024 in Atlanta, GA at the Georgia World Congress Center.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

JULY 11, 2024

Case A 43 year old male with a history of DM II, hyperlipidemia, and a family history of myocardial infarction presented to a family clinic with two days of epigastric pain that started after consuming a meal. He described the pain as a “crushing and discomforting” feeling with no radiation.

Outcomes 112

Outcomes Stenosis Outpatient Echocardiogram 112

Dr. Smith's ECG Blog

MARCH 9, 2013

This male in his 40's had been having intermittent chest pain for one week. He awoke from sleep with crushing central chest pain and called ems. EMS recorded a 12-lead, then gave 2 sublingual nitros with complete relief of pain. Type B waves are deeper and symmetric. Wellen's syndrome is a Reperfusion syndrome.

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia Angina 52

Dr. Smith's ECG Blog

JUNE 27, 2021

A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chest pain, sharp, radiating down left arm, cramping, that waxes and wanes but never goes completely away. Angiogram: "ACS - Non ST Elevation Myocardial Infarction. This is a HUGE myocardial infarction.

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

There was a good outcome. We believe this represents a form of “toxicomythology” given the millions of doses of beta -blockers administered in the past to patients with hyperadrenergic states, and a paucity of evidence of adverse outcomes (12). This would treat both SVT or sinus tachycardia. Later, he was found to have used cocaine.

Tachycardia 52

Tachycardia Chest Pain Pharmacology Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 14, 2023

Non-randomized trials show better outcomes (neurologic survival) using this device; see this article in Resuscitation: Head and Thorax Elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival. Finally, head-up CPR (which was not used here), makes for better resuscitation.

Cardiac Arrest 98

Cardiac Arrest Chest Pain Defibrillator STEMI 98

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest. Troponin was ordered. Eur J Emerg Med.

Chest Pain 82

Chest Pain Ischemia Cardiogenic Shock Myocardial Infarction 82

Dr. Smith's ECG Blog

OCTOBER 26, 2011

This 42 yo diabetic male presented with cough and foot pain. In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

JANUARY 2, 2016

A middle aged male presented with chest pain. Birnbaum writes: "In patients with ACS without LVH, ST depression with negative T waves in the lateral leads is a sign of sub-endocardial ischemia and is an independent predictor of adverse outcome [11 – 13]. Here is his ECG ( Figure 1 ): What do you think? Baseline EKG, no MI.

Ischemia 52

Ischemia Chest Pain STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

JUNE 18, 2013

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Studies show that 30% of NonSTEMI have an occluded infarct artery at the time of angiography done 24 hours after presentation. This patient had continued and ongoing pain. This is because of subtle ECG findings.

STEMI 52

STEMI Chest Pain Myocardial Infarction Webinar 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.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Plan was for admission for chest pain workup. Gottlieb SO, et al.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chest pain. It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. Triage ECG (no prior for comparison): Computer algorithm read: "Sinus rhythm, low voltage QRS, inferior myocardial infarction, probably old."

STEMI 78

STEMI Myocardial Infarction Ischemia Academic 78

Dr. Smith's ECG Blog

APRIL 17, 2023

Full case details and outcomes are below. The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? Repeat 0157 with ongoing chest pain: Basically the same features diagnostic of LAD occlusion. Physician: "No STEMI."

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Chest Pain STEMI Document 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. Smith's ECG Blog

NOVEMBER 3, 2017

Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. This is the initial ED ECG of a 46 year old male with chest pain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 Annals of Emergency Medicine 2012;60:45-56. QRS V2 = 15.5

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

JULY 31, 2018

This is diagnostic of myocardial infarction. In middle age women, it accounts for 22-35% of all ACS presentations 1,3 , and the reported incidence of ST-elevation myocardial infarction in this subset of patients is variable, but estimated to be between 24-50% 4. She felt more comfortable being admitted. Int J Cardiol.

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SCAD Chest Pain Myocardial Infarction Ischemia 52