Dr. Smith's ECG Blog

JANUARY 5, 2024

The patient said his chest pain was 4/10, down from 8/10 on presentation. Although it is statistically unlikely, multiple plaque ruptures are possible. The PDA plaque was also bulky, but was not described as inflamed or ulcerated. The PDA plaque was also bulky, but was not described as inflamed or ulcerated.

Angina 120

Angina Plaque Document Stent 120

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!!

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

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. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again. An angiogram is a " lumenogram " and does not "see" the extraluminal plaque.

Plaque 66

Plaque Stent Stents Chest Pain 66

Dr. Smith's ECG Blog

SEPTEMBER 20, 2011

He did not state he had chest pain, but, then again, he couldn't remember anything. We did a bedside cardiac ultrasound. The ECG and ultrasound could not have been differentiated from acute plaque rupture with occlusion of the RCA. This 80 year old with a history of CABG had a cardiac arrest.

Cardiac Arrest 52

Cardiac Arrest STEMI Ultrasound Chest Pain 52

Circulation

NOVEMBER 11, 2024

Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations.

Aortic valve 40

Aortic valve TAVR Chest Pain Aortic 40

DAIC

FEBRUARY 29, 2024

ET Murphy Ballroom 4 Health 360x Registry: Scalable Workforce for Equitable Access to Point of Care Decentralized Clinical Trials Prevalence of Cardiovascular Disease and Risk Factors Among National Football League Alumni and Their Family Members: Results from the Huddle Study Hózhó (Heart Failure Optimization at Home to Improve Outcomes): A Pragmatic (..)

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Sanjay Gupta

DECEMBER 19, 2022

She asked me why I felt she had had a heart attack and I explained to her that she had had chest pains and the blood test indicating damage to the heart was elevated and that was all we needed to say that she had had a heart attack. On the basis of these findings we told her that she had suffered a heart attack.

Heart attacks 40

Heart attacks Heart Attack Blood Clot Chest Pain 40

Dr. Smith's ECG Blog

JANUARY 4, 2021

Case Continued Bedside ultrasound was performed: This shows an anterior wall motion abnormality, and highly suggests the LAD as the infarct artery. FYI : 52 ng/L is the threshold for "rule in" by European studies as it has a high positive predictive value in the setting of chest pain.

Ischemia 40

Ischemia Pulmonary STEMI Chest Pain 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

To, me these look like anterior wall motion abnormality, but I showed them to one of our ultrasound fellows who is very interested in this. She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. She said: This is a tough one.

STEMI 40

STEMI Chest Pain Hospital Risk Factors 40

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 64

Chest Pain Blog Arrhythmia Critical Care 64

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 52

Chest Pain Aneurysm STEMI Thrombosis 52

DAIC

APRIL 2, 2025

and European societal guidelines that intravascular imaging with either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) should be routinely used during complex coronary stent procedures, s ays first authorGregg W. These results extend the strong recommendations from recent U.S.

Stent 40

Stent Stents Outcomes Coronary Angiogram 40

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 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. As there was ruptured plaque, this is NOT Prinzmetal's angina. It is just as dangerous, as there is a ruptured plaque with thrombus (which lysed) in the proximal LAD. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, There was good flow.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

APRIL 13, 2025

A man in his early 30s was walking when he developed central chest pain which was non-radiating, then had a syncopal event with bowel incontinence, and when he woke up he had ongoing chest pain. Notes never having symptoms like this before, pain is so severe its causing SOB. He called 911. Embolism with lysis.

Chest Pain 84

Chest Pain Embolism STEMI Plaque 84

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. or 2) Inferior and lateral OMI that is beginning to reperfuse, even though the patient still has chest pain? ECG 1 What do you think?

Chest Pain 109

Chest Pain Ischemia Stent Stents 109

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Case 1: 20-something woman with chest pain Case 2: 50-something man with chest pain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chest pain. This was ruptured plaque with thrombus. And almost all of them could be detected by bedside ultrasound.

Chest Pain 105

Chest Pain STEMI Aortic Ultrasound 105

Dr. Smith's ECG Blog

MARCH 17, 2025

Written by Willy Frick A man in his 60s with a history of hypertension and 40 pack-year history presented to the ER with 1 day of intermittent, burning substernal chest pain radiating into both arms as well as his back and jaw. It has been stuttering, lasting 10 minutes at a time with associated diaphoresis.

STEMI 81

STEMI Chest Pain Myocardial Infarction Document 81