Dr. Smith's ECG Blog

MARCH 27, 2025

Below is the first ECG, signed off by the over-reading cardiologist agreeing with the computer interpretation: ST elevation, consider early repolarization, pericarditis, or injury. Theres ST elevation in V3-4 which meets STEMI criteria, which could be present in either early repolarization, pericarditis or injury. What do you think?

STEMI 80

STEMI Chest Pain Pericarditis Ischemia 80

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Of course the patient was saddled with the erroneous "pericarditis" diagnosis after CTs ruled also ruled out PE and dissection. Both were awake and alert with normal vital signs. What do you think?

STEMI 125

STEMI Chest Pain Blog Pericarditis 125

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. Peak troponin, echocardiographic findings, and long term outcome are unknown. There is sinus rhythm with PACs and PVCs. Learning Points: 1.

Chest Pain 52

Chest Pain Pericarditis Embolism Stents 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

ECG of pneumopericardium and probable myocardial contusion shows typical pericarditis Male in 30's, 2 days after Motor Vehicle Collsion, complains of Chest Pain and Dyspnea Head On Motor Vehicle Collision. RBBB in blunt chest trauma seems to be indicative of several RV injury. ST depression. Myocardial Contusion?

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

JANUARY 12, 2023

Written by Pendell Meyers, edits by Smith Two patients presented with acute chest pain/pressure. Two patients with chest pain. Learning Points It takes dedicated learning and observation of outcomes and serial ECGs to learn how to distinguish subtle OMI patterns from OMI mimics like the cases above.

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

Ken Grauer, MD

SEPTEMBER 21, 2024

For example, considering whatever symptoms that the patient may have had ( ie, chest pain, palpitations, shortness of breath, etc. ) — what this might mean in view of the ECG we are looking at. To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age." Figure-2: I've labeled t he initial ECG.

Chest Pain 120

Chest Pain Blog Thrombosis Tachycardia 120

Dr. Smith's ECG Blog

JANUARY 17, 2024

Written by Jesse McLaren Two patients presented with acute chest pain, and below are the precordial leads V1-6 for each. The initial computer and final cardiology interpretation was a differential: “ST elevation, consider early repolarization, pericarditis, or injury.” Are there 1 or 2 Leads that give you the answer?

Chest Pain 118

Chest Pain STEMI Myocardial Infarction Blog 118

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. A patient with OMI can have a totally normal ECG!"

Myocardial Infarction 123

Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Dr. Smith's ECG Blog

JANUARY 9, 2023

No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. 24 yo woman with chest pain: Is this STEMI?

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician.

Ischemia 123

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

JULY 18, 2014

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. such Q-waves are associated with larger MI and worse outcomes (2. What complication is the patient with post-infarction regional pericarditis at risk for?

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 5, 2011

T-wave to ST ratio is greater than 4 in lead V6, making pericarditis unlikely (also there were no symptoms of pericarditis). It turns out that this was a 27 yo African American male who presented with pressure-like (non-pleuritic) chest pain and dyspnea. There is ST elevation diffusely: 2 mm in V2, 3.5 mm in V3, 2.5

Chest Pain 52

Chest Pain STEMI Pericarditis Cardiac Arrest 52

Dr. Smith's ECG Blog

JULY 7, 2013

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. Although the patient has had pain for 4 days, could the artery have fully occluded only within hours? There was some SOB. Very unlikely. Raitt et al.) [and

STEMI 52

STEMI Myocardial Infarction Pericarditis Ultrasound 52

Dr. Smith's ECG Blog

MARCH 11, 2016

A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 Post-infarction Regional Pericarditis (PIRP) PIRP happens when MI is transmural, all the way from subendocardium to subepicardium, thus leading to inflammation of the subepicardium (next to the pericardium).

Myocardial Infarction 52

Myocardial Infarction Pericarditis Angina STEMI 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. As always, takotsubo cardiomyopathy and focal pericarditis can mimic OMI, but takotsubo almost never mimics posterior MI, and both are diagnoses of exclusion after a negative cath. Could this outcome have been prevented with emergent cath? Here is his first ED ECG: What do you see?

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2024

Written by Jesse McLaren, with edits from Meyers Four patients presented with chest pain or shortness of breath, and ECGs labeled ‘inferior STEMI’. In addition, ischemic STD in aVL is highly sensitive for inferior OMI, and excludes pericarditis. Using principles of hyperacute T waves, do any have inferior occlusion MI?

STEMI 119

STEMI Chest Pain Pericarditis Coronary Artery Disease 119

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Scenario 1 : The patient presents with 24 hours of substernal chest pain. The exception is with postinfarction pericarditis , in which a completed transmural infarct results in inflammation of the subepicardial myocardium and STE in the distribution of the infarct, and which results in increased STE and large upright T-waves.

Chest Pain 88

Chest Pain Pericarditis Myocardial Infarction Dementia 88