Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. His prehospital ECG was diagnostic of inferior posterior OMI. The patient was in clinical shock with a lactate of 8. He appeared gray in color, with cool skin.

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Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

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. A single DES stent was placed, and the patient did well post-procedure.

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Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Case submitted by Rachel Plate MD, written by Pendell Meyers A man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He also noted a bilateral "odd feeling" in his arms. He stated it was similar to prior heart attacks.

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Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack 52

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. It was opened and stented. is worrisome!

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Chest Pain Myocardial Infarction Stents Stent 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 J Cardiol.

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Chest Pain Myocardial Infarction STEMI Article 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

A 60-something woman called EMS for chest pain. link] Clinical Course I don't know if the medics noticed these ECG findings or not, but if not, they recognized the value of serial ECGs in a patient with chest pain. The medics administered aspirin (no Nitroglycerine), and the pain resolved. #5: mm in V2 and 0.65

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Chest Pain STEMI Stents Stent 121

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.

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Chest Pain Myocardial Infarction Blog Stents 131

Dr. Smith's ECG Blog

APRIL 12, 2013

A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. He had no chest pain. Medications were aspirin, clopidogrel, metoprolol, and simvastatin. He was in acute distress from pulmonary edema, with a BP of 180/110, pulse 110.

STEMI 52

STEMI Pulmonary Stents Stent 52

Dr. Smith's ECG Blog

MARCH 27, 2025

After only 90 minutes of chest pain, the first troponin was unsurprisingly in the normal range at 11ng/L (normal <26 in males and <16 in females), so the emergency physician waited for repeat troponin. Chest pain still persists. Paged cardiology 0800: patient complains of chest pain. Cardiology aware.

STEMI 80

STEMI Chest Pain Pericarditis Ischemia 80

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. The patient was sent home with a prescription for omeprazole to treat presumed peptic disease.

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Outcomes Stenosis Outpatient Echocardiogram 113

Dr. Smith's ECG Blog

AUGUST 28, 2020

There is new data showing better outcomes when bystander lesions (non-culprit) are stented. == MY Comment by K EN G RAUER, MD ( 8/28/2020 ): == Dr. Smith highlights a number of important lessons to be learned from today’s case. Sotalol prolongs the QT 7. I limit my comments to some additional points of interest.

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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!

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Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

JULY 14, 2024

Sent by anonymous, written by Pendell Meyers Case 1: A man in his 50s presented with acute chest pain. The cath lab was activated, and then not cancelled, and the angiogram showed 99% TIMI 2 flow proximal LAD culprit lesion, stented in less than 90 minutes of arrival. Outcome of case 2? Normal vital signs. Normal vitals.

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AFIB Stents Stent Chest Pain 105

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. mV compared to 0.05-0.1

Pericarditis 52

Pericarditis Chest Pain Stents Stent 52

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.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

JUNE 12, 2016

There was no chest pain or SOB, at least none reported by Dr. Lee. Given that this patient has no chest pain, one must be skeptical of such a diagnosis. Outcome : She ruled in for MI by troponins and went for angiogram. An 80% thrombotic RCA was stented. This case was sent by Arthur Lee. This is not normal.

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Chest Pain Ischemia STEMI Stents 52

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. Patient 2 Clinical Course and Outcome: This patients first ECG was sent to the EM physician who said it did not meet STEMI criteria, but wisely agreed with EMS to get serial ECGs during transport.

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STEMI Chest Pain Blog Pericarditis 125

Dr. Smith's ECG Blog

JULY 2, 2023

This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." Chest pain or discomfort) What do you think? The total duration of chest pain was 30-45 minutes.

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Chest Pain Angina Coronary Angiogram Blog 52

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. A stent was placed. Type B waves are deeper and symmetric.

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Chest Pain Myocardial Infarction Ischemia Angina 52

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. On day 3 of hospitalization she underwent coronary angiography, revealing a 95% lesion in the mid-LAD which was stented. There is sinus rhythm with PACs and PVCs.

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Chest Pain Pericarditis Embolism Stents 52

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

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 = 3.5 100% LAD occlusion. He underwent CABG. QRS V2 = 15.5

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Chest Pain STEMI Bradycardia Stenosis 52

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. It was stented.

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Chest Pain Thrombosis Myocardial Infarction STEMI 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. It was opened and stented. Culprit, stented) 3. The patient had never had pain like this before.

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Ischemia Chest Pain STEMI Stenosis 40

Dr. Smith's ECG Blog

JUNE 24, 2016

In that case, the patient did not have chest pain but was 36 years old. This patient does not have chest pain but is elderly and that increases the pretest probability by a huge amount.

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STEMI Chest Pain Stents Stent 40

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

JULY 31, 2018

The lesion was stented. The 1st “lesson” is, “All bets are off” — when an adult of any age presents to the ED with new-onset chest discomfort. Although by the time you are reading My Comment, you already know the outcome in this case — GO BACK and Take Another Look at the initial ECG @ Time = 0:00 ( TOP tracing in Figure-1 ).

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SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

A 40 something otherwise healthy man presented with substernal chest pain. They were stented. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. It had occurred once 3 days prior and resolved without any medical visit. What do you think? The peak troponin was 1863 ng/L.

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Chest Pain STEMI Article Myocardial Infarction 52

DAIC

APRIL 2, 2025

Stone, MD Mount Sinai Health System tim.hodson Wed, 04/02/2025 - 15:26 March 31, 2025 Using intravascular imaging (IVI) to guide stent implantation during complex stenting procedures is safer and more effective for patients with severely calcified coronary artery disease than conventional angiography, the more commonly used technique.

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Stents Stent Outcomes Coronary Angiogram 40

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

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Chest Pain Defibrillator STEMI Coronary Artery Disease 135

Dr. Smith's ECG Blog

JUNE 23, 2024

Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. He did not remember whether he had experienced any chest pain. (TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Two subsequent troponins were down trending.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

Delayed angiogram found a 95% mid RCA occlusion that was stented. 1] The patient did not have a good outcome because their ECG was labeled ‘normal’ but in spite of it. Smith : this proves my impression that the inferior T-waves on the first ECG are hyperacute.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

DAIC

MARCH 28, 2025

TheNational Institute for Health and Care Excellence(NICE) recommends CCTA as the first-line investigation for patients with chest pain due to suspected CAD, highlighting its importance in improving diagnostic certainty. viii, ix, x, xi, xii, xiii, xiv, xv GE HealthCaredesigned Revolution Vibe to address these challenges.

Technology 59

Technology Coronary Artery Disease Atrial Fibrillation Medicare 59

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

DECEMBER 11, 2023

See this case: Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. This is different from nitroglycerin which produces vasodilation and can improve by pain improving myocardial perfusion. Here is the angiogram after stent placement. link] Opiates are associated with worse outcomes in Myocardial Infarction.

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Myocardial Infarction Chest Pain STEMI Blood Pressure 123

DAIC

APRIL 11, 2024

At two years, people who underwent preventive PCI were 89% less likely to experience the composite primary endpoint of cardiac death, heart attack in the target vessel, revascularization due to ischemia in the target vessel or hospitalization for unstable or progressive chest pain compared with people who received medications alone.

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Plaque Heart Attack Heart attacks Coronary Artery Disease 111

DAIC

MAY 14, 2024

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death. Accessed May 2024. Kirtane, Yongjian Wu, William Wijns, Weixian Yang, Martin B. Leon, Shubin Qiao, Gregg W.

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Coronary Artery Disease Interventional Cardiology Innovation Physiology 111