Dr. Smith's ECG Blog

APRIL 9, 2024

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. It is easy to say pericarditis in such a case.

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Chest Pain Pericarditis Blog Risk Factors 89

American Heart News - Heart News

JUNE 17, 2024

DALLAS, June 17, 2024 — About 40,000 people in the United States experience recurrent pericarditis, or inflammation of the sac-like structure that protects the heart, which can cause chest pain and may lead to fluid buildup around the heart muscle.

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Ken Grauer, MD

FEBRUARY 24, 2023

The patient was discharged with a diagnosis of acute pericarditis — and treated with a full course of colchicine and ibuprofen. The ultimate discharge diagnosis was acute pericarditis. ( From the information provided — I would not make the diagnosis of acute pericarditis. Figure-1: The initial ECG in today's case.

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Pericarditis Blog Chest Pain Coronary Angiogram 78

ECG Cases

NOVEMBER 16, 2021

Jesse McLaren guides us through 9 cases and explains how pericarditis is a diagnosis of exclusion through 3 simple steps: 1. Exclude more serious causes of chest pain, eg wraparound LAD occlusion, inferior OMI 2. Exclude complications of pericarditis, eg myocarditis, large pericardial effusion 3.

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Pericarditis Chest Pain Blog STEMI 52

Dr. Smith's ECG Blog

APRIL 25, 2023

Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. First, many on Twitter said "Pericarditis". This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. Angiogram : "Acute onset chest pressure with diaphoresis." "ECG

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Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Sanjay Gupta

DECEMBER 19, 2022

Pericarditis refers to inflammation of the pericardium The pericardium is a sac within which the heart sits. Acute inflammation of this sac is known as acute pericarditis. About 5% of patients who present to A+E with chest pain which is not deemed to be a heart attack or angina are ultimately diagnosed with pericarditis.

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Pericarditis Heart Attack Heart attacks Chest Pain 40

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms.

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Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). As already mentioned, this patient could have post-infarction regional pericarditis from a large completed MI. Sinus tachycardia has many potential causes. Hammill SC.

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Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

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Chest Pain Blog Critical Care Arrhythmia 66

Dr. Smith's ECG Blog

AUGUST 4, 2024

Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. Pericarditis maybe." Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. Meyers' words — "is one of the rare ECGs that is actually specific for pericarditis".

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ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

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Chest Pain STEMI Blog Embolism 52

Dr. Smith's ECG Blog

JUNE 17, 2018

A middle-aged patient with lung cancer had presented to clinic complaining of generalized malaise, cough, and chest pain. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. PR depression, which suggests pericarditis 4. Here is that ECG: What do you think? There is sinus tachycardia.

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Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

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?

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Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Upon questioning patient, he denies having any chest pain or chest tightness of any sort. Assessment:" " Nonspecific ST elevation from V1-V4 , question of early repolarization versus pericarditis , question of acute current of injury and ? Pericarditis would be even more unlikely in someone without chest pain.

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Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She felt nauseous and lightheaded with no neurologic deficits.

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Dr. Smith's ECG Blog

DECEMBER 10, 2019

This is a previously healthy male teenager who was awoken by chest pain. The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain.

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Chest Pain Pericarditis Ischemia Pediatrics 52

Dr. Smith's ECG Blog

JUNE 20, 2018

A 40 something woman with a history of hyperlipidemia and additional risk factors including a smoking history presented with substernal chest pain radiating to "both axilla" as well as the upper back. She was reportedly "pacing in her room while holding her chest". Clinician and EKG machine read of acute pericarditis.

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Dr. Smith's ECG Blog

FEBRUARY 12, 2024

Post op chest pain Typical of post-op pericarditis (postpericardiotomy syndrome) There is ST Elevation in II ＞ III, and STE in V3-5, but with flat T-wave. The ST elevation is far more prominent than the T-wave and this is what I see as the defining feature differentiating OMI from pericarditis.

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Pericarditis Chest Pain Bradycardia Aortic 83

Dr. Smith's ECG Blog

JANUARY 10, 2020

He presented to the ED because he developed sudden severe, sharp, pleuritic (but not positional), substernal and left mid to lower chest pain. It could also be due to pericarditis or myocarditis, but I always say that "you diagnose pericarditis at your peril." Pericarditis? Learning Points: 1. What happens then?

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Dr. Smith's ECG Blog

MARCH 26, 2024

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. Chest pain, SOB, Precordial T-wave inversions, and positive troponin.

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Chest Pain Embolism Pulmonary Ischemia 71

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

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Chest Pain Embolism Pulmonary Tachycardia 137

Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). The patient was still with ongoing chest pain at the time ECG #1 was done.

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Circulation: Arrhythmia and Electrophysiology

DECEMBER 21, 2023

Postablation chest pain consistent with pericarditis was reduced with colchicine (4% versus 15%; HR, 0.26 [95% CI, 0.09–0.77];P=0.02) Colchicine did not prevent atrial arrhythmia recurrence at 2 weeks (31% versus 32%; hazard ratio [HR], 0.98 [95% CI, 0.59–1.61];P=0.92) 2.02];P=0.89). 11.53];P<0.001). 1.99];P=0.55).CONCLUSIONS:Colchicine

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All About Cardiovascular System and Disorders

APRIL 25, 2024

There are other tests also for tuberculous pericarditis, but they not as sure as growing the bacterium in culture. Inflammation of pericardium as inflammation elsewhere can be painful and cause chest pain. But pericardial effusion can build up slowly without much pain.

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Dr. Smith's ECG Blog

AUGUST 24, 2012

A young otherwise healthy man presented with 4 hours of sharp 10/10 substernal chest pain. But there was some doubt as to whether it might be pericarditis because of the ST elevation in I and II, without ST depression in III. This is a good sign for myocardial infarction and does not happen in pericarditis. BP was 160.

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Dr. Smith's ECG Blog

DECEMBER 20, 2013

Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?

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Pericarditis Chest Pain Pulmonary STEMI 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

days of chest pain that started as substernal and crushing in nature awakening him from sleep and occasionally traveling to right side of neck. The pain was described as constant, worse with deep inspiration and physical activity, sometimes sharp. He reported 1.5

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Pediatrics Pericarditis COVID-19 Congenital Heart Disease 112

Dr. Anish Koka

JANUARY 1, 2023

The case reports Case 1 involves a 26 year old man who developed pericarditis after the Pfizer vaccine. Pericarditis, an inflammation of the sac the heart lives in, developed about 7 days after the Pfizer vaccine. The diagnosis was made based on classic findings of inflammation on an electrocardiogram associated with acute chest pain.

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Dr. Smith's ECG Blog

OCTOBER 17, 2022

In fact, there was no chest pain either. Pericarditis? If you were thinking that this is pericarditis, that would be possible in the absence of any clinical information. However, there is zero PR depression which would be VERY unusual in pericarditis. P.S.: Acute pericarditis may produce diffuse ST elevation.

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Pericarditis Chest Pain Blog Arrhythmia 52

Open Heart

MARCH 9, 2022

Myocarditis and pericarditis are inflammatory conditions of the heart that present a range of symptoms, often including chest pain, fatigue, breathlessness and palpitations that may be irregular due to cardiac rhythm disturbances.

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COVID-19 Pericarditis Chest Pain 40

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o.

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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. See this case: A man his 50s with chest pain.

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Myocardial Infarction Chest Pain STEMI Blood Pressure 122

Dr. Smith's ECG Blog

MAY 16, 2023

Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chest pain". Acute pain?" -(Dr. I immediately responded: "cool fake!

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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 ). These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. This is OMI until proven otherwise.

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Dr. Smith's ECG Blog

NOVEMBER 13, 2022

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. Such an out-of-proportion STE is virtually never seen in pericarditis. STE in lead I and II are more subtle.

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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. To Emphasize: Given that Patient #2 presented with chest pain — I did not feel that I could rule out an acute event solely on the basis of ECG #2. Will you activate the cath lab?

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Dr. Smith's ECG Blog

MARCH 3, 2023

Additionally, the App also includes a chest pain section, namely EDACS risk score, which is already a well known and validated tool for the approach to acute chest pain (many thanks for its developers and their courtesy for letting us to use it in our App, Martin Than, MD; John Pickering, BSc, PhD, BA and Dylan Flaws, MSc, PhD).

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