Chest Pain Physiology Pulmonary 
Ken Grauer, MD
SEPTEMBER 22, 2023
KEY Point: Although true that patients with longstanding, severe pulmonary disease may manifest a QRST complex in standard lead I with marked overall reduction in QRST amplitude ( See ECG Blog #65 — regarding Schamroth’s Sign ) — you should never normally see a completely flat line in any of the standard limb leads.
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. CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time.
Dr. Smith's ECG Blog
MARCH 12, 2018
Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG. This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1.
Dr. Smith's ECG Blog
FEBRUARY 28, 2020
My answer: "This is classic for PE, but it can also be present in any hypoxia due pulmonary hypoxic vasoconstriction and resulting acute pulmonary hypertension and acute right heart strain. The ECG of most patients with longstanding pulmonary disease show more r wave progression than I see in ECG #1. This is NOT Wellens.
Dr. Smith's ECG Blog
FEBRUARY 12, 2023
There was no chest pain. This suggests that there is pulmonary hypertension and thus possibly RVH. The estimated pulmonary artery systolic pressure is 31 mmHg + RA pressure. Acute posterior OMI would be a prime concern for the ECG in Figure-1 — IF the patient presented with cardiac-sounding chest pain.
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed.
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.
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