Dr. Smith's ECG Blog

MARCH 27, 2023

The patient's nitro was dialed up to 100 mcg/min but the pain persisted. The ACC/AHA guidelines mandate less than 2 hours cath for patients with ACS with refractory pain, pulmonary edema, or electrical or hemodynamic instability.

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Chest Pain Ischemia Myocardial Infarction Blog 52

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

SEPTEMBER 30, 2019

Case written and submitted by Ryan Barnicle MD, with edits by Pendell Meyers While vacationing on one of the islands off the northeast coast, a healthy 70ish year old male presented to the island health center for an evaluation of chest pain. The chest pain started about one hour prior to arrival while bike riding.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

A middle aged male presented at midnight after 14 hours of constant, severe substernal chest pain, radiating to his throat and to bilateral jaws, and associated with diaphoresis. The pain was not positional, pleuritic, or reproducible. Patients with ACS and acute pulmonary edema 3. It was not relieved by anything.

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Chest Pain STEMI Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 10, 2019

This is a previously healthy male teenager who was awoken by chest pain. He was seen at another hospital and found to have a slightly elevated troponin, then underwent a CT pulmonary angiogram (PE) protocol which revealed a right sided pneumonia. 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

MARCH 4, 2023

The ECG is rather classic for pulmonary embolism, and indeed this was a large acute PE. More on the ECG in pulmonary embolism: The ECG in this patient has both precordial T-wave inversions AND T-wave inversion in lead III. this is highly suggestive of pulmonary embolism. This is a classic S1Q3T3. Most S1Q3T3 is not due to PE.

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Chest Pain Embolism Tachycardia Pulmonary 52

Dr. Smith's ECG Blog

MARCH 26, 2024

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Acute pulmonary embolism was confirmed on CT: The patient did well with treatment. So everything about this ECG screams acute PE.

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Chest Pain Embolism Pulmonary Ischemia 68

Dr. Smith's ECG Blog

APRIL 9, 2023

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell Meyers A man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath.

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Chest Pain Ischemia Stenosis Pulmonary 52

Dr. Smith's ECG Blog

AUGUST 14, 2023

Written by Pendell Meyers, with some edits by Smith A man in his 40s with many comorbidities presented to the ED with chest pain, hypotension, dyspnea, and hypoxemia. The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) An 80-something woman who presented with chest pain and dyspnea.

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Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

APRIL 22, 2019

He then went on to say: "40-something with chest pain for one hour. Burning pain subxiphoid and into throat." I’ll emphasize that the generalities stated here may not pertain early on in the process in a patient with a worrisome history of new-onset chest pain. Had episode of nausea and dizziness when it started.

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Chest Pain Arrhythmia Ischemia STEMI 52

Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

years, and the time from computed tomography pulmonary angiography (CTPA) diagnosis to interventional treatment averaged 2.8 ± 2.2 years, and the time from computed tomography pulmonary angiography (CTPA) diagnosis to interventional treatment averaged 2.8 ± 2.2 m, with an average age of 62.0 ± 16.0 m, with an average age of 62.0 ± 16.0

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Embolism Pulmonary Chest Pain 52

Dr. Smith's ECG Blog

MAY 20, 2024

A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.

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Chest Pain Blood Pressure Ischemia STEMI 125

Dr. Smith's ECG Blog

JUNE 11, 2011

Explanation : The patient had a worrisome history: 59 yo with significant substernal chest pressure, so his pretest probability of MI (and even of STEMI) is reasonably high. Only 5-13% of patients with chest pain and LBBB have MI; many fewer have coronary occlusion. Moreover, and importantly, there was sinus tach.

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Chest Pain Ischemia STEMI Tachycardia 52

Dr. Smith's ECG Blog

JULY 7, 2023

An 80-something woman who presented with chest pain and dyspnea. An old formal echo was found from 6 mo ago: Dilated right ventricle with septal flattening and estimated right ventricular systolic pressure of 70 mmHg (significant pulmonary hypertension). After all, this patient did also present with chest pain. ) — See below.

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Chest Pain AFIB Blog Atrial Fibrillation 52

Dr. Smith's ECG Blog

APRIL 12, 2013

He had no chest pain. He was in acute distress from pulmonary edema, with a BP of 180/110, pulse 110. He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema. The hypertension alone is the likely etiology of the pulmonary edema.

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STEMI Pulmonary Stents Stent 52

The British Journal of Cardiology

FEBRUARY 4, 2025

A 50-year-old man presented to the emergency department with symptoms of acute chest pain, dizziness, and headache. If the dissection extends into the aortic arch branches, ensuring adequate cerebral perfusion during surgery is crucial to preventing stroke. His blood pressure was 180/110 mmHg and heart rate was 100 bpm.

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Aortic Blood Pressure Chest Pain Embolism 40

Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

Genetic protein S (PS) deficiency caused by PROS1 gene mutation is an important risk factor for hereditary thrombophilia.Case introductionIn this case, we report a 28-year-old male patient who developed a severe pulmonary embolism during his visit. The patient had experienced one month of chest pains, coughing and hemoptysis symptoms.

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Embolism Pulmonary Chest Pain Thrombosis 40

Dr. Smith's ECG Blog

AUGUST 3, 2018

In the evening, a middle-aged man complained of chest pain at the nursing home. His chest pain was vague. He mentioned "cancer" and "chest". Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS. He was awake, with a pulse of 130 and BP of 50/30. Fluids were started.

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Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. He later developed mild continuous chest pain, that he describes as the sensation of someone standing on his chest. Xray was consistent with pulmonary vascular congestion. 40 mg of furosemide was given.

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 118

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema. Finally, the presentation is dyspnea, not chest pain. What do you think? Also, we know the patient had a stent.

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Aneurysm Stent Stents Chest Pain 124

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. Although it was technically difficult and the quality therefore leaves a lot to be desired, you can still make out RV dilation and septal flattening which is much more suggestive of pulmonary embolism than OMI.

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Cardiogenic Shock Ultrasound Tachycardia Pulmonary 127

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

large ASD, partial anomalous pulmonary venous return, significant tricuspid regurgitation, carcinoid valvular disease, etc,) 2) Conditions causing pressure overload of the RV. Any cause of pulmonary hypertension. There is normal axis, normal R-wave progression in the precordial leads and no intraventricular conduction abnormalities.

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Pulmonary Tricuspid Chest Pain Cardiogenic Shock 116

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. The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. A 70-something y.o.

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Chest Pain Myocardial Infarction STEMI Pericarditis 115

Frontiers in Cardiovascular Medicine

JULY 2, 2024

Preoperative ultrasonography and CT examination revealed that the filter retraction hook was very likely to penetrate the SVC wall and its tip was very close to the right pulmonary artery. During this procedure, the patient experienced discomfort, such as chest pain and palpitations, but these symptoms disappeared when procedure completed.

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Chest Pain Pulmonary Aneurysm 52

Dr. Smith's ECG Blog

OCTOBER 6, 2024

This patient had the onset of chest pain 24 hours before arrival to the ED. I wonder if this patient had pulmonary disease? The relevance of recognizing pulmonary disease on ECG — is that this may sometimes render assessment for acute OMI more difficult — although this was not the case in today's tracing. (

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Hospital Chest Pain Blog Pulmonary 77

Frontiers in Cardiovascular Medicine

JULY 16, 2024

We present a case report of the adverse effects of amiodarone and review its characteristics.Case reportA 73-year-old Asian female with a history of paroxysmal atrial fibrillation managed with amiodarone, well-controlled hypertension, and no substance abuse presented with gastrointestinal distress and dizziness, without chest pain or palpitations.

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Atrial Fibrillation Chest Pain Arrhythmia Pulmonary 52

Dr. Prateek Bhatnagar

SEPTEMBER 14, 2020

63 years old Afsar Khan resident of Karwan, Hyderabad had been having coronary artery disease and chest pain on exertion for about a year. With increasing chest pain, he underwent coronary angiography in June. His HRCT chest showed no active Covid 19 lesions and some pulmonary fibrosis.

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COVID-19 Chest Pain Pulmonary Coronary Artery Disease 52

Dr. Smith's ECG Blog

APRIL 26, 2017

There was no chest pain or SOB at the tim of the ECG: Computerized QTc is 464 ms A previous ECG from 8 years prior was normal. Absence of chest pain or SOB at the time of the ECG is important; had the patient had active chest pain, I would have recommended at least an emergency formal echo, if not cath lab activation.

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Chest Pain STEMI Ultrasound Pulmonary 52

Dr. Smith's ECG Blog

APRIL 27, 2012

56 y/o male who presented with 12/10 severe chest pain starting at 3AM, radiating to his upper back. He had a history of pulmonary embolism but was no longer on coumadin and states the pain is different. The patient was very hypertensive and had back pain, so they did a CT of his chest to rule out dissection.

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Chest Pain Embolism Ischemia Pulmonary 52

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.

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Blog Chest Pain Bradycardia Physiology 176

Ken Grauer, MD

AUGUST 16, 2024

Today’s patient presented to the ED not only with chest pain — but also with shortness of breath , therefore with a history potentially consistent with the diagnosis. For a 10-minute video review on reading Pulmonary CT Scan — WATCH_this_VIDEO by Dr. Jake Gibbons.

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Blog Tachycardia Cardiogenic Shock Pulmonary 156

DAIC

MAY 2, 2024

a developer of cellular and cell-derived therapeutics for the treatment of cardiovascular and pulmonary diseases, today announced the primary endpoint results of the open label roll-in cohort of the CardiAMP Cell Therapy in Chronic Myocardial Ischemia Trial. Getty Images milla1cf Thu, 05/02/2024 - 10:12 May 2, 2024 — BioCardia, Inc. ,

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Ischemia Angina Heart Failure Outcomes 95

Dr. Smith's ECG Blog

MAY 10, 2023

A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.

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Coronary Angiogram Chest Pain Stenosis STEMI 52

EMS 12-Lead

APRIL 9, 2024

There was no chest pain. V1 and V2 are probably placed too high on the chest given close morphological similarity to aVR. The CXR demonstrated no pulmonary edema. The fall was not a mechanical etiology. He denied any specific prodrome of gross palpitations, however did endorse feeling quite dizzy just before the event.

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Ischemia Stenosis Chest Pain Coronary Artery Disease 116

Circulation

NOVEMBER 11, 2024

Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chest pain for 2 months. EKG, cardiac enzymes, and Initial echocardiogram(TTE) was unremarkable.

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Chest Pain Echocardiogram Document Ischemia 40

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.

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Chest Pain Pulmonary Embolism Tachycardia 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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Pericarditis Chest Pain Aortic Blog 52