ECG Guru

MARCH 30, 2025

I do not know if this patient has a history of cardiac disease or a recent complaint of chest pain, but T wave inversion and some biphasic T waves makes me think of reperfusion changes, reflecting a recent M.I. This would demand further investigation, probably with a temporary transvenous pacemaker as a safeguard measure.

Dysrhythmia 64

Dysrhythmia RN Chest Pain Electrophysiology 64

ECG Guru

MARCH 30, 2025

I do not know if this patient has a history of cardiac disease or a recent complaint of chest pain, but T wave inversion and some biphasic T waves makes me think of reperfusion changes, reflecting a recent M.I. This would demand further investigation, probably with a temporary transvenous pacemaker as a safeguard measure.

Dysrhythmia 64

Dysrhythmia RN Chest Pain Electrophysiology 64

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

MAY 19, 2022

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. His symptoms of chest pain and shortness of breath were attributed to an asthma exacerbation during exercise.

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

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. Is there STEMI?

Chest Pain 52

Chest Pain SCAD STEMI Blog 52

Ken Grauer, MD

MARCH 1, 2024

No clear history for recent chest pain — but the patient "has not been well" for the previous week. This is because in addition to no conduction of any of the sinus P waves — the presence of a fairly regular escape pacemaker that is usually seen with complete AV block is absent. A permanent pacemaker is needed. =

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Blog Pacemaker Chest Pain Heart Disease 198

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. It is true that assessment of pacemaker tracings for acute ST-T wave changes can be challenging. Sent by Pete McKenna M.D.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

JUNE 14, 2017

There was apparently no syncope and he had no bony injuries, but he did complain of left sided chest pain. His chest was tender. A Patient with Ischemic symptoms and a Biventricular Pacemaker A bedside cardiac ultrasound was normal. An ECG was recorded: Avinash was understandably confused by this ECG. IVCD type rhythm ??

Chest Pain 52

Chest Pain Congenital Heart Disease Article Congenital 52

JAMA Cardiology

JANUARY 2, 2024

This case report describes a diagnosis of cardiac perforation secondary to pacemaker placement in a male patient in his 80s who presented with pulsing chest pain.

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Pacemaker Chest Pain 40

HeartRhythm

SEPTEMBER 8, 2024

An 80-year-old man with renal disease on hemodialysis, coronary artery disease, complete heart block and a dual chamber leadless pacemaker (LP) implanted because of previous bacteremia, presented with syncope. While in the hospital, he had witnessed ventricular fibrillation (VF) arrest for which he received external defibrillation.

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Defibrillator Pacemaker Chest Pain Coronary Artery Disease 40

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI. She's had multiple PCI procedures. Below the ECG image quality is enhanced using the PM Cardio App.

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Chest Pain Pacemaker Ischemia Stents 111

Dr. Smith's ECG Blog

SEPTEMBER 14, 2014

He presented with chest pain, not relieved by nitro, pain reproducible on exam and centered around the pacemaker insertion site. He presented with chest pain, not relieved by nitro, pain reproducible on exam and centered around the pacemaker insertion site.

Chest Pain 52

Chest Pain Pacemaker Cardiomyopathy STEMI 52

Dr. Smith's ECG Blog

MAY 31, 2011

A 76 year old male presented with chest pain. or there is a low atrial pacemaker and 3rd degree block, and sinus brady, and junctional escape). For couple very interesting related posts, click here. Here is the initial ECG: Rhythm: slow and regular. p-waves are not conducting down to ventricles. What is it really?

Chest Pain 52

Chest Pain Pacemaker STEMI 52

Ken Grauer, MD

OCTOBER 13, 2023

She was hemodynamically stable — and did not have chest pain, lightheadedness or syncope. Is a pacemaker needed? The ECG in Figure-1 was obtained from a woman in her 60s — who was seen in the ED ( E mergency D epartment ) as part of her evaluation for trauma following a motor vehicle accident. Is this " high -grade" AV block?

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Blog Arrhythmia Bradycardia Download 158

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

Later, I found old ECGs: 5 month prior in clinic: V5 and V6 look like OMI 9 months prior in clinic with no chest symptoms: V5 and V6 look like OMI 1 year prior in the ED with chest pain: V5 and V6 sure look like a STEMI For this ECG and chest pain in the ED, the Cath lab activated. But the angiogram was clean.

Stroke 70

Stroke Strokes Chest Pain Cardiomyopathy 70

Dr. Smith's ECG Blog

JANUARY 9, 2024

She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. She presented to the emergency department after a couple of days of chest discomfort. Learning points *A patient with tachydysrhythmia and chest discomfort needs immediate rhythm or rate control. small squares in width (260ms).

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Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Ken Grauer, MD

OCTOBER 27, 2023

My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. Given this patient's older age — if nothing "fixable" is found, she most likely has SSS ( S ick S inus S yndrome ) and will need a pacemaker ( See ECG Blog #342 for more on SSS ).

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Blog Pacemaker Bradycardia Arrhythmia 103

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Case: The call was an elderly gentleman who was at home when he experienced a sudden onset of vague chest discomfort along with nausea, and left arm aching. He has a pacemaker for an unknown arrhythmia reason, and has a hx of a PE but is not anti-coagulated currently. It was central and constant.

Chest Pain 52

Chest Pain Myocardial Infarction Pacemaker Cardiogenic Shock 52

Wellnest

DECEMBER 21, 2022

If you experience any symptoms, such as chest pain, dizziness, unusual tiredness or fatigue, shortness of breath, or irregular heartbeat, your doctor would want you to go for an ECG test to find out the underlying cause. ECG testing is also carried out to see how medicines work during treatment and the pacemaker's functioning.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

She went on to describe her chest pain as a "buffalo sitting on my chest" and a "weird" sensation in her jaw for 1 hour prior to arrival, associated with lightheadedness and diaphoresis. The patient was given fentanyl initially for chest pain with minimal effect and then vomited which was followed by zofran and famotidine.

Chest Pain 52

Chest Pain Critical Care Article Pacemaker 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

Although the patient reported experiencing mild pressure-like chest pain, there was suspicion among clinicians that this might be indicative of an older change. Again, see Ken's discussion below) Discussion continued The absence of pace spikes suggests this is not a pacemaker/ICD-related rhythm in this patient with an ICD.

Tachycardia 112

Tachycardia Blog Ischemia Heart Failure 112

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Case An elderly patient had acute chest pain and 911 was called. The medics recorded the following initial ECG at time 0: The computer read (see below) gives no further comment beyond ventricular pacemaker. I am hoping to moderate the arrogance that so many who write to me and talk to me frequently encounter." What do you think?

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

There was no chest pain. Isoprenalin was discontinued, and a temporary transveous pacemaker was implanted. The patient stabilized following pacemaker placement. This was written by Magnus Nossen The patient is a female in her 50s. She presented with a one week hx of «dizziness» and weakness.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Smith's ECG Blog

JANUARY 26, 2023

This may lead to a series of symptoms similar to “pacemaker syndrome” ( ie, dizziness, fatigue, light-headedness, presyncope/syncope, dyspnea and/or chest pain ). On occasion — implantation of a permanent pacemaker may be needed in a patient with a marked 1st-degree AV block ( ie, PR interval significantly greater than 0.30

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Pacemaker Chest Pain AFIB Blog 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. Written By Magnus Nossen — with edits by Ken Grauer and Smith. The below ECG was recorded.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

EMS 12-Lead

JUNE 1, 2022

He received a permanent pacemaker during the subsequent inpatient stay. Smith and Myers found that in otherwise classic Wellens syndrome – that is, prior anginal chest pain that resolves with subsequent dynamic T wave inversions on the ECG – even the T waves of LBBB behave similarly. [2] Hospital transport was unremarkable.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

This 60-something with h/o COPD and HFrEF (EF 25%) presented with SOB and chest pain. MAT has at least 3 distinct P-wave morphologies, but there is no single dominant pacemaker (i.e., The patient in this case presented with dyspnea and chest pain. Here is the ECG: What do you think?

Atrial Fibrillation 52

Atrial Fibrillation Tachycardia Arrhythmia Pulmonary 52

Ken Grauer, MD

JUNE 2, 2023

ie, with syncope-presyncope, fatigue, dyspnea, chest pain? ). I would bet that this patient will soon receive a permanent pacemaker. = Checking the rest of the Holter to see if episodes of bradycardia primarily occur at night? Follow-Up: Our interpretation of this Holter was passed on to the patient's primary physician.

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Blog Bradycardia Arrhythmia Tachycardia 78

Dr. Smith's ECG Blog

JULY 19, 2024

Written by Pendell Meyers, with edits by Smith A man in his 80s presented with acute chest pain and normal vital signs. We need more such ECGs for training but we are constantly working on the algorithm and one day it will make this diagnosis. == But isn't ongoing chest pain in NSTEMI a guideline indication for emergent angiography?

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Chest Pain Myocardial Infarction Pacemaker STEMI 115

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

See these similar cases: A man in his sixties with chest pain Why is there inferior ST elevation, and would you get posterior leads? If you can safely and easily increase the patient's heart rate, you can convert the patient to sinus and repeat the ECG to see if the atrial repolarization wave was the cause of the concern for ischemia.

Blog 52

Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A recent similar case: A 40-something with chest pain. Therefore, she underwent temporary pacemaker placement and overdrive pacing at a rate of 90 bpm to keep the heart rate up in order to prevent these PVCs triggering ventricular arrhythmia. Is this inferior MI? There is a bigeminy with very Bizarre looking PVCs.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

MARCH 15, 2023

She did notice something slightly wrong subjectively, but had no palpitations, chest pain, or SOB, or any other symptom. This middle-aged patient has a remote history of cardiac surgery as a young child for a "heart murmur". Her Apple Watch suddenly told her that she is in atrial fibrillation. She was on no medications.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Ken Grauer, MD

OCTOBER 4, 2024

As to ST-T wave changes in the 12-lead ECG — although some leads show T wave inversion (ie, in leads III, V3 and V4 ) — I did not think this looked acute in this 30-year old man without chest pain. Many favored pacemaker implantation at this time. Figure-2: I’ve labeled atrial activity from Figure-1 with colored arrows.

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Blog Bradycardia Arrhythmia Pacemaker 103

Wellnest

JULY 19, 2023

When a person experiences a heart attack or myocardial infarction, they may feel chest pain and other symptoms in different parts of their body. These issues can only be addressed in an ICCU (Intensive Coronary Care Unit) setting, where temporary pacemakers and defibrillators are available.

Heart Attack 52

Heart Attack Heart attacks Blood Pressure Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 8, 2015

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). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Syncope with Exertion (EGSYS) 7.

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Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. How does a pacemaker accomplish RBBB morphology? ECG 1 What do you think?

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Chest Pain Tachycardia Pacemaker Defibrillator 102

Dr. Smith's ECG Blog

MARCH 8, 2025

2:34 PM, following right heart catheterization She then went into atrial fibrillation with complete heart block and junctional escape rhythm prompting placement of transvenous pacemaker. He had no chest pain, dyspnea, or any other anginal equivalent, and his vital signs were normal. In the midst of this, she went into VF.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75