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. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Normal RV function.

Chest Pain 52

Chest Pain SCAD STEMI Blog 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. More outcome Peak troponin I was 0.58 Case A 40-something male presented to triage. Am Heart J.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Article 52

Coronary Artery Disease Journal

JUNE 3, 2024

This study investigated the clinical characteristics and clinical outcomes in patients with VSA and OCAD, especially regarding provoked spasm phenotypes and sites. We defined positive epicardial spasm as ≥90% transient stenosis and usual chest symptoms or ischemic ECG changes.

Stenosis 40

Stenosis Angina Chest Pain Coronary Artery Disease 40

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. The red arrow shows a roughly 80% stenosis of the proximal LAD. The blue arrow shows another stenosis of the LAD distal to the first diagonal branch of about 99%. The green arrow shows a 95% stenosis of the ostium of the first diagonal branch.

Outcomes 112

Outcomes Stenosis Outpatient Echocardiogram 112

Dr. Smith's ECG Blog

JULY 31, 2013

A 20-something male presented from an outside facility with Chest pain. He came with this ECG from the outside facility, recorded 1 hour after pain onset: There is at least 2 mm of inferior ST elevation, with reciprocal ST depression in aVL, ST flattening in V4-V6, and T-wave inversion in V2. Vital signs were normal.

Chest Pain 52

Chest Pain Aneurysm STEMI Ischemia 52

Dr. Smith's ECG Blog

AUGUST 28, 2020

Here I annotate it: This shows 100% occluded circumflex (red arrow) and a 90% stenosis of the LAD (Yellow arrow). The LAD was thought to be not thrombotic, but a chronic tight stenosis. My THOUGHTS on ECG #1: We are told that the patient in today’s case had an episode of severe chest pain 3 nights prior to admission.

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

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!

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

JULY 3, 2018

Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. The pain initially started the day prior to presentation. The ST elevation from today is ~0.2

Pericarditis 52

Pericarditis Chest Pain Stents Stent 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

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

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

SEPTEMBER 17, 2023

COPD, Idiopathic PAH, acute or chronic PE, pulmonary valve stenosis, etc) 3) Conditions affecting RV myocardial contractility, such as ARVD or RV infarction The ECGs does not really show any signs of chronic RV dilation or hypertrophy. Any cause of pulmonary hypertension. Our THANKS to Dr. Magnus Nossen for sharing this case with us.

Pulmonary 116

Pulmonary Tricuspid Chest Pain Cardiogenic Shock 116

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

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 ng/ml) A 45 year old male called 911 for chest pain: The QTc was 400 ST Elevation at 60 ms after the J-point in lead V3 = 3.5 Angiogram showed a critical LAD thrombotic stenosis.

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

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."

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Case A 47 year old male called 911 for severe chest pain. Jason asked me if I thought it is due to occlusion (without either of us knowing the outcome), and this was my answer: This is a posterolateral MI. LM: No significant stenosis. LAD: luminal irregularities with a 40% stenosis at the take-off of a D3.

Ischemia 40

Ischemia Chest Pain STEMI Stenosis 40

Dr. Smith's ECG Blog

JANUARY 12, 2023

Written by Pendell Meyers, edits by Smith Two patients presented with acute chest pain/pressure. There is no mention of whether the patient had any pain at this time. Cath was done at around 9AM: Culprit lesion mid-LAD, 99% stenosis, pre-intervention TIMI flow not listed, PCI performed with TIMI 3 flow and 0% stenosis resulting.

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Anything more on history? Left main?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. The day prior to presentation (about 12 hours prior to presentation) he described sudden onset chest pain and shortness of breath while gardening in his back yard. He had no further pain and went to bed that night with no complaints.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

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. The culprit lesion was a complex calcified mid LAD stenosis involving the first and second diagonal branches. Am Heart J.

STEMI 78

STEMI Myocardial Infarction Ischemia Academic 78

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.

Chest Pain 121

Chest Pain STEMI Cardiogenic Shock Heart Failure 121

DAIC

MARCH 4, 2025

Early detection through regular heart check-ups, including listening for murmurs, can lead to timely treatment and improved outcomes. The earlier we catch it, the more treatment options we have, and the better the outcome for the patient. Many people with HVD may not experience symptoms until the disease reaches an advanced stage.

Heart Valves 52

Heart Valves Aortic valve Aortic Stenosis 52

Coronary Artery Disease Journal

MAY 27, 2024

Objectives Patients presenting with suspected ST segment elevation myocardial infarction frequently have symptoms in addition to chest pain, including dyspnea, nausea or vomiting, diaphoresis, and lightheadedness or syncope. These symptoms are often regarded as supporting the diagnosis of infarction.

Chest Pain 40

Chest Pain Myocardial Infarction Stenosis Hospital 40

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. So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart Attack 120

DAIC

MAY 1, 2024

We believe the tools, resources, and information shared at the meeting will provide the healthcare community with greater expertise to improve patient outcomes and also connect with their interventional cardiology colleagues,” said SCAI President George D. Dangas, MD, PhD, MSCAI , Icahn School of Medicine - Mt.

Interventional Cardiology 105

Interventional Cardiology Aortic valve TAVR Peripheral Arterial Disease 105

Dr. Smith's ECG Blog

JUNE 15, 2023

Written by Pendell Meyers Both of these cases were sent to me with no information other than adults with acute chest pain. Case 1 An elderly male presented with chest pain. Case 2 A man in his 60s presented with acute chest pain, about 1 hour prior to evaluation: What do you think? We will study this soon.

STEMI 98

STEMI Chest Pain Stenosis Outcomes 98

Dr. Anish Koka

MAY 16, 2023

Soviet biologist Trofim Lysenko famously rejected the objective reality of Mendelian genetics because it clashed with the Marxist philosophy that the environment, not genetics, was the primary determinant of outcomes. Atypical angina is classified as having any two of the three symptoms, and non-anginal pain any one of the three symptoms.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

He was at the gym when he had the onset of chest pain. Angiography revealed a very tight LAD stenosis with some flow (confirming the reperfusion that we see on the ECG). A stent was placed, and the patient had an excellent outcome with no wall motion abnormality. This patient is 38 years old with hyperlipidemia.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Defibrillator STEMI 52

Dr. Smith's ECG Blog

JUNE 27, 2024

A reliable study would keep track of all patients with shockable arrest and analyze the ones who were not enrolled to see their outcomes. This is a primary ST-T wave change , that in a patient with chest pain ( or cardiac arrest ) — indicates an ongoing acute event until proven otherwise. This study failed to do so.

Defibrillator 113

Defibrillator Cardiac Arrest STEMI Chest Pain 113

DAIC

SEPTEMBER 4, 2024

When we observed that bicuspid aortic valve is kind of a risk marker for this group with bad outcomes, we specifically wanted to see whether young individuals who present clinically due to problems related to bicuspid aortic valve disease may also have rare genetic variants that predict complications such as needing valve surgery.”

Aortic valve 52

Aortic valve Bicuspid/Mitral Aortic Research 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Case 3 : Male in 30's with chest pain, cough, and fever. Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was A male in late middle age with a history of RCA stent 8 years prior complained of chest pain. What do you think? He has clinical pneumonia. Called 911.

STEMI 40

STEMI Chest Pain Cardiac Arrest Stents 40

Dr. Paddy Barrett

SEPTEMBER 5, 2023

This distinction is crucial to understand as most heart attacks result from plaque ruptures of less than 70% stenosis, which is the type of narrowing missed by most exercise stress tests 2. Estimates of Angiographic Stenosis of Culprit Coronary Artery Lesions in 50 Consecutive Patients Experiencing Sudden Coronary Death.

Plaque 52

Plaque Heart Attack Heart attacks Exercise 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. TIMI 0/1 flow).(61,62) Knotts et al. Zoghbi GJ, Misra VK, Brott BC, et al.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. 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). orthostatic vitals b.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. She awoke in the morning with sharp chest pain which worsened throughout the morning. As her pain worsened, so did her dyspnea. This was written by Hans Helseth.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

Written by Pendell Meyers, few edits by Smith A woman in her 70s was woken from sleep by midsternal chest pain radiating to left arm with nausea. The history in today's case is classic for an acute cardiac event — as this older woman was awakened from sleep by chest pain radiating to her left arm with nausea.

STEMI 81

STEMI Chest Pain Echocardiogram Stents 81