Chest Pain, Pericarditis and Tachycardia

Acute chest pain and ST Elevation. CT done to look for aortic dissection.

Dr. Smith's ECG Blog

MARCH 9, 2024

Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. What do you think?

Chest Pain

Chest Pain Pericarditis Aortic Echocardiogram

A 29 year old male with chest pain, ST Elevation, and very elevated troponin T

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.

Chest Pain

Chest Pain Pericarditis Blog Tachycardia

ECG Blog #448 — A Young Man with Chest Pain.

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. The sinus tachycardia is a definite concern that something acute may be ongoing. Figure-2: I've labeled t he initial ECG.

Chest Pain

Chest Pain Blog Thrombosis Tachycardia

Three prehospital ECGs in patients with chest pain

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.

Chest Pain

Chest Pain Ischemia Pericarditis Tachycardia

Chest Pain and Inferior ST Elevation.

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. There is sinus tachycardia. Symptoms other than chest pain (malaise, cough in a cancer patient) 2. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology.

Chest Pain

Chest Pain Pericarditis Tachycardia Myocardial Infarction

Why the sudden shock after a few days of malaise?

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 ). Sinus tachycardia has many potential causes. This is especially true for the elderly patient with sinus tachycardia. What is the cause of the sudden tachycardia?

Cardiogenic Shock

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction

A man in his late 30s with acute chest pain and ST elevation

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. Do you have a prior? Positional?

Chest Pain

Chest Pain Pericarditis Tachycardia STEMI

"Pericarditis" strikes again

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.

Pericarditis

Pericarditis Chest Pain Aortic Blog

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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.

Chest Pain

Chest Pain Embolism Pulmonary Tachycardia

Noisy, low amplitude ECG in a patient with chest pain

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. We can see enough to make out that the rhythm is sinus tachycardia. It was not worse with exertion or relieved by rest.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

A man in his 50s with shortness of breath

Dr. Smith's ECG Blog

MARCH 26, 2024

Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. Moreover, there is tachycardia.

Chest Pain

Chest Pain Embolism Pulmonary Ischemia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Chest trauma was suspected on initial exam. The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Gunshot wound to the chest with ST Elevation Would your radiologist make this diagnosis, or should you record an ECG in trauma? He was intubated for altered mental status.

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

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) This study aimed to evaluate a short-term anti-inflammatory treatment with colchicine following ablation of AF.METHODS:Patients scheduled for ablation were randomized to receive colchicine 0.6

Atrial Fibrillation

Atrial Fibrillation Ablation Chest Pain Atrial Flutter

Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

OCTOBER 8, 2023

All of the patients presented with chest pain , and they are all in triage. I completely agree with Dr. Nossen that in this patient with new CP and sinus tachycardia with LAHB — that the T waves in each of the inferior leads are hyperacute ( ie, clearly disproportionately "bulky" given size of the QRS in these leads ).

Ischemia

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest

Cardiologist declines taking patient to the cath lab. Patient dies.

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Apparently he denied chest pain. Other than tachycardia, Other than slight tachycardia, vitals were within normal limits (including oxygen saturation). JAMA 2000) showed that 1/3 of patients with STEMI, and 1/3 of patients with NSTEMI, present without chest pain. Here is his first ED ECG: What do you see?

Chest Pain

Chest Pain STEMI Blog Tachycardia

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. Chest pain, SOB, Precordial T-wave inversions, and positive troponin. What is the Diagnosis? Now another, with ultrasound.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

A Patient with Respiratory Failure and a Computer "Normal" ECG

Dr. Smith's ECG Blog

MARCH 11, 2019

You do NOT see this in normal variant STE, nor in pericarditis. In such cases, it is common for tachycardia to exaggerate the ST Elevation And, in fact, there was no new acute MI at this visit - troponins did not rise again. At some point he returned with chest pain, and all these findings were put into place.

Chest Pain

Chest Pain Ischemia Aneurysm Myocardial Infarction

What does this ECG with significant ST Elevation represent?

Dr. Smith's ECG Blog

JULY 21, 2019

They were recorded 12 minutes apart: "Hey Steve, 30-something with one week of chest pain, mostly right-sided, better with sitting up.": I learned more about the history: 30-something African American with 5-7days of sharp R-sided shoulder/scapula/chest discomfort, presented with sinus tachycardia. What do you think?

Chest Pain

Chest Pain Myocardial Infarction Pericarditis Angina

A woman in her 20s with syncope

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia. The second most common cause of medical cardiac tamponade is acute idiopathic pericarditis.

Tachycardia

Tachycardia Pericarditis Ultrasound Blood Pressure

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

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. Sinus Tachycardia ( common in any trauma patient. ). ST depression. Myocardial Contusion?

Arrhythmia

Arrhythmia Blog Chest Pain Cardiac Arrest

Cardiac Arrest, hypotension, tachycardia

Dr. Smith's ECG Blog

DECEMBER 22, 2010

Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP). Patients who present with chest pain or cardiac arrest and have an ECG diagnostic of STEMI could have myocardial rupture. 5 of 6 presented with chest pain and an ECG indicating reperfusion therapy, but were detected by bedside ultrasound.

Cardiac Arrest

Cardiac Arrest Tachycardia STEMI Chest Pain

A woman in her 40s with acute chest pain and shortness of breath

Dr. Smith's ECG Blog

NOVEMBER 21, 2024

Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. 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

Chest Pain Embolism Pulmonary Tachycardia

Cardiovascular Update

Acute chest pain and ST Elevation. CT done to look for aortic dissection.

A 29 year old male with chest pain, ST Elevation, and very elevated troponin T

ECG Blog #448 — A Young Man with Chest Pain.

Three prehospital ECGs in patients with chest pain

Chest Pain and Inferior ST Elevation.

Why the sudden shock after a few days of malaise?

A man in his late 30s with acute chest pain and ST elevation

"Pericarditis" strikes again

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Noisy, low amplitude ECG in a patient with chest pain

A man in his 50s with shortness of breath

A teenager involved in a motor vehicle collision with abnormal ECG

Colchicine to Prevent Atrial Fibrillation Recurrence After Catheter Ablation: A Randomized, Placebo-Controlled Trial

Should we activate the cath lab? A Quiz on 5 Cases.

Cardiologist declines taking patient to the cath lab. Patient dies.

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

A Patient with Respiratory Failure and a Computer "Normal" ECG

What does this ECG with significant ST Elevation represent?

A woman in her 20s with syncope

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Cardiac Arrest, hypotension, tachycardia

A woman in her 40s with acute chest pain and shortness of breath

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