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.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

JUNE 21, 2023

Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. The primary care physician there evaluated this patient and deemed the chest pain to be due to gastrointestinal causes. link] ] Outcome The patient emerged neurologically intact.

Chest Pain 98

Chest Pain Cardiac Arrest STEMI Defibrillator 98

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. Long term outcome is unavailable. His history included known heart failure with prior EF 18%, insulin dependent diabetes, and polysubstance abuse.

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Chest Pain STEMI Cardiogenic Shock Heart Failure 121

Dr. Smith's ECG Blog

MARCH 10, 2025

Written by Jesse McLaren A 50 year old presented to triage with one hour of chest pain, and the following ECG labeled normal by the computer (GE Marquette SL) algorithm. They concluded, "Our findings increase confidence in the normal automated GE Marquette 12 SL ECG software interpretation to predict a benign outcome.

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Chest Pain Outcomes STEMI Electrocardiogram 89

Dr. Smith's ECG Blog

JANUARY 29, 2024

This was sent by Sam Ghali @EM_RESUS A 44 year old man presented with chest pain The tech came running with the ECG as the computer called "STEMI!" Tell me the outcome! What do you think? Sam sent this to me and asked: "What do you think, Steve?" My answer: --Tough one! --But He responded: --You nailed it!

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Chest Pain STEMI Blog Outcomes 96

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.

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Chest Pain STEMI Atrial Flutter Ischemia 114

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 ). As a result, this 45-year old man did not experince any delay in treatment — and a large diagonal branch of the LAD was stented with good outcome.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

FEBRUARY 14, 2024

A 41-year-old male who presents to the emergency department with chest pain. Patient reports approximately 2 hours prior to arrival he developed a sharp chest pain that radiates into his left arm and left lower leg. Describes the radiating pain as numbness/tingling. No shortness of breath. No recent travel.

Chest Pain 110

Chest Pain Angina Ischemia Outcomes 110

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.

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Chest Pain Myocardial Infarction Anatomy Angina 117

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.

Chest Pain 111

Chest Pain Myocardial Infarction Stents Stent 111

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. Smith : "What was the outcome?" x the QRS amplitude in any of V1-V4.

Chest Pain 114

Chest Pain Aneurysm Stents Stent 114

Frontiers in Cardiovascular Medicine

FEBRUARY 24, 2025

This results in severe chest pain or discomfort, with the subsequent release of cardiac biomarkers, and alterations in the electrocardiogram. It can cause diminished heart function and mortality if not treated properly with suitable measures. were male, with the average age of 56.313.5

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Hospital Myocardial Infarction Chest Pain Electrocardiogram 98

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

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Written by Jesse McLaren Four patients presented with chest pain. 1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department.

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Chest Pain STEMI Electrocardiogram Ischemia 119

Dr. Smith's ECG Blog

JUNE 23, 2024

He did not remember whether he had experienced any chest pain. Within a few days, the patient was extubated and was neurologically intact. However, he did not remember much from the day of the arrest. At his family's request, he was transferred to a hospital closer to his home to continue care. He was admitted to cardiology.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

American College of Cardiology

OCTOBER 30, 2024

Several abstracts presented at TCT 2024, taking place Oct.

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Chest Pain Coronary Artery Disease TAVR Bicuspid/Mitral 60

Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think?

Chest Pain 119

Chest Pain STEMI Outcomes Electrocardiogram 119

MIBHS

MARCH 31, 2025

Signs include: Sudden loss of consciousness No pulse or breathing Collapse without prior chest pain or discomfort If someone experiences sudden cardiac arrest, it is crucial to begin CPR immediately and call the local emergency number. Without prompt treatment, parts of the heart muscle may become damaged or die.

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Cardiac Arrest Heart attacks Heart Attack Chest Pain 52

JAMA Cardiology

FEBRUARY 27, 2024

This prespecified secondary analysis of the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial investigates the association of age with clinical outcomes after computed tomography and coronary angiography in stable chest pain.

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Chest Pain Coronary Artery Disease Outcomes 59

Dr. Smith's ECG Blog

JANUARY 27, 2024

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab? What do you think?

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Chest Pain STEMI Aneurysm Stents 117

Circulation: Cardiovascular Interventions

MARCH 9, 2025

However, the impact of nickel hypersensitivity on post-procedural outcomes remains poorly understood. The primary endpoint was the incidence of device syndrome, a composite of patient-reported symptoms (chest pain, palpitations, migraines, dyspnea, and rash).Results:Of vs. 20.6%, p < 0.001).

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Chest Pain Cardiovascular Interventions Document Arrhythmia 70

Heart BMJ

AUGUST 26, 2024

Acute pericarditis (AP) is the second most common cardiac cause of chest pain, diagnosed when at least two of the following criteria are met: characteristic pleuritic chest pain, pericardial rub on auscultation, new typical ECG changes (such as widespread ST-elevation or PR-depression) and pericardial effusion on imaging.

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Pericarditis Chest Pain Outcomes Biomarkers 105

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 Stents 98

Dr. Smith's ECG Blog

JUNE 5, 2023

A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Thus, in our ECG research, we need to find a surrogate outcome that reflects the state of the artery at the time of the ECG. Here is his initial ED ECG: What do you think?

Chest Pain 96

Chest Pain STEMI Physiology Stents 96

Frontiers in Cardiovascular Medicine

JANUARY 29, 2025

years and experiencing chest pain. Most cases were male and involved chest pain. Early screening for chest pain and investigating MPXV infection's pathogenesis and clinical features are crucial for differential diagnosis during outbreaks. The prognosis was generally good, with no reported death.

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Chest Pain Public Health Heart Failure Risk Factors 40

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A healthy 45-year-old female presented with chest pain, with normal vitals. The patient was previously healthy, with no atherosclerotic risk factors, and developed chest pain after an episode of stress. The pain was crushing retrosternal, radiated to the arms and was associated with lightheadedness.

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Chest Pain Pericarditis SCAD STEMI 66

DAIC

APRIL 2, 2025

I suspect its use will rapidly accelerate given study after study now showing reductions in death, stent thrombosis, and nearly every other adverse outcome after PCI when intravascular imaging is used. Patients with severely calcified coronary lesions were randomized at 104 sites across the United States.

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Stents Stent Outcomes Coronary Angiogram 40

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

FEBRUARY 4, 2023

There were no injuries and no chest pain and he appeared well. He complained of 3 days of diarrhea and abdominal pain. Pretest probability: Especially when there is no Chest pain, or there are very atypical symptoms, one should be very suspicious of the diagnosis of coronary occlusion unless the ECG is crystal clear.

Chest Pain 52

Chest Pain STEMI Hospital Blog 52

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The primary outcomes were sensitivity/specificity of 1) STD in lead I ≥ 0.5 mm and 2) STE in lead V1 ≥ 0.5 mm, stratified by presence or absence of posterior (inferobasal) MI, as determined by ≥0.5 mm STD in lead V2, for differentiating RVMI from non-RVMI.

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

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. The average age of the patients was 65.23 ± 12.66 years, The median AG levels were 7.60 mmol/L

Chest Pain 52

Chest Pain Cardiogenic Shock Cardiac Arrest Myocardial Infarction 52

Heart BMJ

JULY 25, 2024

Introduction Coronary CT angiography (CTA) is recommended as the first-line diagnostic evaluation for patients presenting with chest pain. To learn how coronary CTA can help to select patients for revascularisation, plan PCI and guide procedures in the catheterisation laboratory. To realise the benefit of CT-guided PCI.

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Chest Pain Laboratory Outcomes 95

Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Discharge diagnoses and MI classification should reflect patient outcomes of Occlusion vs non-Occlusion MI, not arbitrary STE vs Non-STE criteria, or rapid vs delayed time to cath. What do you think?

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Chest Pain STEMI Blog Arrhythmia 66

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. TIMI flow alone cannot be used as an outcome definition for OMI or STEMI. =

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 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

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 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. It is highly associated with proximal LAD occlusion and bad outcomes. EMS recorded the following ECG: What do you see? I have annotated it here: The lines mark the end of the QRS and beginning of the ST segment.

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Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty 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." Lobo et al. examined SCAD presenting as STEMI (unlike Hassan et al.

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52