Medical Xpress - Cardiology

OCTOBER 29, 2024

Until now, patients with aortic stenosis—a narrowing of one of the heart's main valves—have had to wait until symptoms become severe before undergoing valve replacement.

Stenosis 80

Stenosis Aortic Chest Pain 80

Dr. Smith's ECG Blog

JANUARY 27, 2024

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab? What do you think?

Chest Pain 117

Chest Pain STEMI Aneurysm Stents 117

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

A 60-something yo female presented w/ exertional chest pain for 3 days. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. But the patient has active chest pain.

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Chest Pain Echocardiogram Blog Ischemia 78

Dr. Smith's ECG Blog

JUNE 5, 2023

A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Here is the angiogram: --Culprit is 100% stenosis in the proximal RCA. (It Here is his initial ED ECG: What do you think? Then the ED doc would be dependent on that first ECG.

Chest Pain 96

Chest Pain STEMI Physiology Research 96

Dr. Smith's ECG Blog

JANUARY 25, 2024

A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain. 2 years prior he had an angiogram which showed 90% proximal stenosis of the circumflex. The pain did not resolve with NTG, and so he went to emergent angiography: 1. Left main: no obvious stenosis.

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Chest Pain Stenosis Stents Stent 75

Dr. Smith's ECG Blog

MARCH 1, 2023

Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. The chest pain was described as sharp and radiated to both arms. During active chest pain an ECG was recorded: Meyers ECG interpretation: Sinus tachycardia, normal QRS complex, STD in V2-V6, I, II, III and aVF.

Chest Pain 52

Chest Pain Ischemia Tachycardia Stenosis 52

Dr. Smith's ECG Blog

DECEMBER 14, 2022

Sent by Drew Williams, written by Pendell Meyers A man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin.

Chest Pain 52

Chest Pain STEMI Blog Stenosis 52

Dr. Smith's ECG Blog

MARCH 17, 2023

Submitted by anonymous, written by Pendell Meyers A woman in her 50s presented to the Emergency Department with chest pain and shortness of breath that woke her from sleep, with diaphoresis. See these other cases of arterial pulse tapping artifact: A 60 year old with chest pain Are these Hyperacute T-waves?

Chest Pain 52

Chest Pain Coronary Angiogram Circulation Electrocardiogram 52

Dr. Smith's ECG Blog

MARCH 27, 2023

The ACC/AHA guidelines mandate less than 2 hours cath for patients with ACS with refractory pain, pulmonary edema, or electrical or hemodynamic instability. Angiogram at 4 hours after ECG 1 (and approximately 6 hours after pain onset): Culprit is 100% stenosis in the mid RCA. No wall motion abnormality.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Isn't it amazing?? Don’t Ignore Bedside Echo Results! —

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

JUNE 17, 2023

Written by Pendell Meyers A middle aged man called EMS for acute chest pain. He had 50% stenosis of the LAD which was deemed not culprit, and all other vessels were normal. EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. I said "Not OMI. No intervention.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

MARCH 1, 2024

But syncope or seizure alone, without chest pain, is not enough to call it Wellens syndrome. Without chest pain, the pretest probability is not very high. Further review of systems with the patient fully awake revealed that the patient had been having chest pain on and off all week.

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Chest Pain Myocardial Infarction Tachycardia Stenosis 108

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. At this time he reported ongoing chest pain and was given aspirin and nitroglycerin.

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Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Upon questioning patient, he denies having any chest pain or chest tightness of any sort. In the absence of chest pain and negative troponin , it appears less likely that he is having acute coronary syndrome though EKG appears concerning. Pericarditis would be even more unlikely in someone without chest pain.

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Chest Pain Coronary Artery Bypass Graft Pericarditis Blog 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

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. It was not relieved by anything. He had no previous medical history. Is it STEMI or NonSTEMI?

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Chest Pain STEMI Aortic Pulmonary 52

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

Written by Jesse McLaren, with edits from Smith A 30 year old with a history of diabetes presented with two days of intermittent chest pain and diaphoresis, which recurred two hours prior to presentation. The chest pain was refractory to nitro so the cath lab was activated: 100% proximal LAD and 99% mid circumflex occlusions.

Chest Pain 52

Chest Pain STEMI Ischemia Stenosis 52

Dr. Smith's ECG Blog

APRIL 14, 2023

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. Pre-intervention.

Chest Pain 52

Chest Pain STEMI Stents Stent 52

Dr. Smith's ECG Blog

APRIL 8, 2022

There is a patient with persistent chest pain and an initial troponin I over 52 ng/L; 52 ng/L has an approximate 70% PPV for acute type I MI in a chest pain patient. Pain was severe and persistent. CT angiography chest assessing for PE and dissection negative. Heparin drip was initiated. Normal RV function.

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Chest Pain SCAD STEMI Blog 52

Dr. Smith's ECG Blog

JUNE 28, 2018

He had suffered a couple bouts of typical chest pain in the last 24 hours. This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. The pain had lasted about one hour. Case A 40-something male presented to triage. There are classic Wellens' waves in V2-V5. Am Heart J.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Article 52

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.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

The New England Journal of Medicine

SEPTEMBER 4, 2024

In a 57-year-old man with chest pain, an ECG obtained by EMS showed widespread ST-segment depressions. At the hospital, left main coronary-artery stenosis was seen on angiography (shown in a video).

Ischemia 59

Ischemia Chest Pain Stenosis Hospital 59

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Since the pathologist does not know the original cross-sectional area of the artery or the amount of compensatory enlargement of the artery from evaluation of a single cross section of the artery at a site of stenosis, the degree of luminal narrowing of that segment cannot be determined. These are typical findings at sites of plaque rupture.

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Ischemia Plaque Stenosis Myocardial Infarction 121

DAIC

MARCH 28, 2024

Collectively, this study shows that Cleerly AI-QCT ISCHEMIA , when used in conjunction with Cleerly LABS, can provide a 3-in-1 approach for the assessment of atherosclerosis, stenosis and ischemia. JACC Cardiovasc Imaging. 2024 Feb 29:S1936-878X(24)00039-1. doi: 10.1016/j.jcmg.2024.01.007. 2024.01.007. Epub ahead of print. PMID: 38483420.

Ischemia 110

Ischemia Chest Pain Atherosclerosis Coronary Artery Disease 110

Dr. Smith's ECG Blog

JUNE 11, 2024

Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. Angiogram findings included: 95% mid RCA stenosis with occluded distal right PDA secondary to thrombus (peristent OMI). Chest pain and a computer ‘normal’ ECG.

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Chest Pain STEMI Blog Exercise 113

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 LM has an irregular 30% distal stenosis, followed by an 80% ostial LAD stenosis, and total occlusion of the LAD proximally with TIMI grade 1 flow in the distal vessel. Type II ischemia.

Ischemia 116

Ischemia Stenosis Chest Pain Coronary Artery Disease 116

Dr. Smith's ECG Blog

JULY 31, 2013

A 20-something male presented from an outside facility with Chest pain. He came with this ECG from the outside facility, recorded 1 hour after pain onset: There is at least 2 mm of inferior ST elevation, with reciprocal ST depression in aVL, ST flattening in V4-V6, and T-wave inversion in V2. Vital signs were normal.

Chest Pain 52

Chest Pain Aneurysm STEMI Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

A 60-something awoke with 10/10 crushing chest pain. The angiogram showed an open artery with 95% stenosis and thrombosis and it was stented. But the patient's chest pain continues and so you order a 2nd ECG (ECG 2 here). He walked in to triage. I would expect that a stent would be placed.

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Chest Pain STEMI Stents Stent 98

Coronary Artery Disease Journal

JUNE 3, 2024

Methods This was a retrospective, observational, single-center study of 403 patients with typical or atypical angina-like chest pain undergoing acetylcholine (ACH) spasm provocation testing and OCAD. We defined positive epicardial spasm as ≥90% transient stenosis and usual chest symptoms or ischemic ECG changes.

Stenosis 40

Stenosis Angina Chest Pain Coronary Artery Disease 40

Dr. Smith's ECG Blog

AUGUST 28, 2020

Here I annotate it: This shows 100% occluded circumflex (red arrow) and a 90% stenosis of the LAD (Yellow arrow). The LAD was thought to be not thrombotic, but a chronic tight stenosis. My THOUGHTS on ECG #1: We are told that the patient in today’s case had an episode of severe chest pain 3 nights prior to admission.

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

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. Wellen's waves indicate that, when the patient was having chest pain, there was occlusion. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o.

Chest Pain 115

Chest Pain Myocardial Infarction STEMI Pericarditis 115

Ken Grauer, MD

FEBRUARY 3, 2024

BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Despite the absence of significant coronary stenosis on her post-arrest cath — the ECG in Figure-1 is clearly diagnostic of an extensive anterolateral STEMI ( presumably from acute LAD [ L eft A nterior D escending ] coronary artery occlusion).

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Blog Cardiac Arrest STEMI Plaque 162

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

On the second morning of his admission, he developed 10/10 chest pain and some diaphoresis after breakfast. The patient was given opiates which improved his chest pain to 7/10. The consulting cardiologist wrote in their note: “Could be cardiac chest pain. She is usually incredibly good at recognizing them!

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Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

OCTOBER 10, 2024

Written by Pendell Meyers A man in his early sixties with no significant medical history (including a "negative cardiac workup a few years ago" for unclear indication) called 911 for acute chest pain constantly for the past 5 hours. However, this patient has active chest pain, and thus this this is inferior-posterior OMI.

Chest Pain 108

Chest Pain STEMI Blog Stenosis 108

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Angiography revealed a 30% nonobstructive stenosis of the mid LAD.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stents 116

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

Here is the clinical story: A 40 year old male with no cardiac history presented with acute substernal chest pain that started 40 minutes prior to arrival. In spite of a relatively short QTc of 376 ms, the very low R-wave amplitude in V4 and the ST Elevation at 60 ms after the J-point in lead V3 contribute to a high final value.

STEMI 130

STEMI Stenosis Plaque Chest Pain 130

Dr. Smith's ECG Blog

SEPTEMBER 14, 2014

He presented with chest pain, not relieved by nitro, pain reproducible on exam and centered around the pacemaker insertion site. Here is his ECG one month prior, on admission for chest pain at that time also: Similar ratios. Here is his ED ECG There is RV Pacing. How could you suspect that this is false positive?

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Chest Pain Pacemaker Cardiomyopathy STEMI 52