Chest Pain, Pericarditis and Ultrasound

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. 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.

Chest Pain

Chest Pain Pericarditis Tachycardia Myocardial Infarction

"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

A 20-something with intermittent then acute chest pain

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. No pericardial effusion on ultrasound." First, many on Twitter said "Pericarditis". This is NOT pericarditis, which virtually NEVER has ST depression any where except aVR. What do you think?

Chest Pain

Chest Pain Pericarditis Blog Cardiomyopathy

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80-something year old with acute chest pain. 3 visits. Fascinating Ultrasound progression

Dr. Smith's ECG Blog

MARCH 15, 2021

An 80-something year old man with history of metastatic cancer had acute onset of chest pain and called 911. There is no typical evolution of MI (so BOTH EKG evolution, and troponin, proves there was no acute MI) 2 weeks later, the patient present with acute chest pain again. He ruled out for MI by troponins again.

Chest Pain

Chest Pain Ultrasound Pericarditis STEMI

You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

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.

Pericarditis

Pericarditis Chest Pain Blog Ultrasound

Pericarditis

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.

Pericarditis

Pericarditis Heart Attack Heart attacks Chest Pain

Viral symptoms, then acute chest pain and this ECG. What do you do?

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? Beware a negative Bedside ultrasound.

Chest Pain

Chest Pain Pericarditis Ultrasound Download

A woman in her 70s with chest pain

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. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?

Chest Pain

Chest Pain Ischemia Aortic Aortic valve

A man in his 50s with shortness of breath

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.

Chest Pain

Chest Pain Embolism Pulmonary Ischemia

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

Dr. Smith's ECG Blog

JUNE 18, 2011

3 hours prior to calling 911 he developed typical chest pain. 1.196 x STE60 in V3 in mm) + (0.059 x computerized QTc) - (0.326 x RA in V4 in mm) Third, one can do an immediate cardiac ultrasound. Medics gave him nitroglycerine sublingual and his pain resolved. This is not pericarditis because: a. greater than 23.4

STEMI

STEMI Pericarditis Hospital Aneurysm

What do you call fluid collection around the heart?

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.

Pericarditis

Pericarditis Cancer Blood Pressure Heart Valves

"The dye don't lie".except when it does. Angiogram Negative, or is it?

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. You can easily imagine this patient getting one of several diagnoses -- vasospasm, MINOCA , pericarditis, or maybe even no diagnosis at all beyond "non-obstructive coronary artery disease." She took an oxycodone and called EMS.

Plaque

Plaque Stents Stent Chest Pain

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? A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. She has already had syncope.

Tachycardia

Tachycardia Pericarditis Ultrasound Blood Pressure

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. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

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

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

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?

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Dr. Smith's ECG Blog

JULY 18, 2014

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP).

STEMI

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock

Large Transmural STEMI with Myocardial "Rupture" of Ventricular Septum

Dr. Smith's ECG Blog

JULY 7, 2013

A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation. Exact pain history was difficult to ascertain. When there is MI extending all the way to the epicardium (transmural), that infarcted epicardium is often inflamed (postinfarction regional pericarditis, or PIRP).

STEMI

STEMI Myocardial Infarction Pericarditis Ultrasound

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. Now another, with ultrasound. This is a quiz.

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

Chest pain and hypotension in a patient who is 3 weeks post STEMI

Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. In the ED he had some continued chest pain and hypotension. Myocardial rupture is usually preceded by postinfarction regional pericarditis (PIRP).

Chest Pain

Chest Pain STEMI Pericarditis Ultrasound

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

Chest Pain and Inferior ST Elevation.

"Pericarditis" strikes again

A 20-something with intermittent then acute chest pain

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80-something year old with acute chest pain. 3 visits. Fascinating Ultrasound progression

You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

Pericarditis

Viral symptoms, then acute chest pain and this ECG. What do you do?

A woman in her 70s with chest pain

A man in his 50s with shortness of breath

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

What do you call fluid collection around the heart?

"The dye don't lie".except when it does. Angiogram Negative, or is it?

A woman in her 20s with syncope

Noisy, low amplitude ECG in a patient with chest pain

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

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves

Large Transmural STEMI with Myocardial "Rupture" of Ventricular Septum

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

Chest pain and hypotension in a patient who is 3 weeks post STEMI

Cardiac Arrest, hypotension, tachycardia

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

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