Post-stent chest pain, revisited
Heart Sisters
JULY 28, 2024
Heart patients with persistent or recurrent post-stent chest pain present “an unmet clinical need”, according to the European Journal of Cardiology.
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Quiz post: two patients with chest pain. Do either, both, or neither have OMI?
Dr. Smith's ECG Blog
MAY 29, 2024
Written by Pendell Meyers Two patients with acute chest pain. Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder. Two patients with chest pain. Do either, neither, or both have OMI and need reperfusion?
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Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!
Dr. Smith's ECG Blog
SEPTEMBER 11, 2024
No Chest Pain, but somnolent. The fact that this is syncope makes give it a far lower pretest probability than chest pain, but it was really more than syncope, as the patient actually underwent CPR and had hypotension on arrival of EMS. Former resident: "Just saw cath report, LAD stent was 100% acutely occluded."
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Do Stents Make You Feel Better?
Dr. Paddy Barrett
DECEMBER 5, 2023
The logic of stenting obstructed coronary arteries is simple. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. But coronary stenting is not the only way to reduce symptoms of angina. All is fixed.
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An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain
Dr. Smith's ECG Blog
MARCH 19, 2024
The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. HPI: Abrupt onset of substernal chest pain associated with nausea/vomiting 30 min PTA.
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A 50-something with chest pain.
Dr. Smith's ECG Blog
SEPTEMBER 3, 2023
This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.
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What happened after the Cath lab was activated for a chest pain patient with this ECG?
Dr. Smith's ECG Blog
MARCH 31, 2024
The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration. The pain was still active at the time of evaluation. Angiogram reportedly showed acute thrombotic occlusion of the first obtuse marginal which was stented. Peak troponin was not recorded. Long term follow up is unavailable.
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Successful Bypass Surgery In Hyderabad After Stents Blocked in Delhi.
Dr. Prateek Bhatnagar
SEPTEMBER 6, 2023
Prateek Bhatnagar Director Cardiac Surgery, on a 50 years man after stents placed in his left main coronary artery at Delhi just 3 months back, had blocked. Mr. Hemant, a resident of Delhi NCR, had developed chest pain (angina). He subsequently underwent stenting procedure in left main coronary artery.
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Do You Need A Stent To Treat Your Heart Disease?
Dr. Paddy Barrett
NOVEMBER 28, 2023
One of the most common questions I get is, “ Do I need a stent to treat my heart disease?” ” Typically, several of this person’s friends have had stents, so it seems natural to ask. First, we must understand what a stent is and why it is used. The stent ‘unblocks’ it. Flow is restored.
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Serial ECGs for chest pain: at what point would you activate the cath lab?
Dr. Smith's ECG Blog
AUGUST 11, 2024
Written by Jesse McLaren A healthy 75 year old developed 7/10 chest pain associated with diaphoresis and nausea, which began on exertion but persisted. Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. What do you think?
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Diabetic patient who had 12 stents in his heart underwent a successful Beating Heart Surgery.
Dr. Prateek Bhatnagar
MAY 11, 2022
A 55 years old diabetic male patient who had 12 stents in his heart underwent a successful beating heart bypass surgery under Dr. Prateek Bhatnagar, Director Cardiac Surgery. The patient was suffering with angina (chest pain) since 2002. The last 3 stents were placed just 6 months back but were not working.
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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.
Dr. Smith's ECG Blog
APRIL 14, 2024
A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike.
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A prehospital ECG in a patient with chest pain. The paramedics tell me it is normal.
Dr. Smith's ECG Blog
JULY 23, 2024
I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. It was opened and stented. They recorded a prehospital ECG at 2112 and said that it was “normal”. It had already been crumpled up and put in the waste basket. So I uncrumpled it: What do you think?
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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.
Dr. Smith's ECG Blog
JUNE 23, 2024
Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. He did not remember whether he had experienced any chest pain. (TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Two subsequent troponins were down trending.
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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.
Dr. Smith's ECG Blog
APRIL 22, 2024
A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. At times the pain does go to his left neck. It is a ssociated with mild dyspnea on exertion.
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Chest pain and T wave inversion, NSTEMI?
Dr. Smith's ECG Blog
AUGUST 10, 2023
Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The pain improved (6/10) but is persisting, which prompted him to visit the Emergency Department. What do you think?
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First DCB Approved; DAPT Bleeds With Low LDL-C; Pre-CABG Cardiac Rehab
Med Page Today
MARCH 5, 2024
(MedPage Today) -- FDA approved the Agent drug-coated balloon (DCB) for coronary in-stent restenosis, making this the first DCB to make it to the U.S. In people with stable chest pain, a coronary. market, manufacturer Boston Scientific announced.
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A 50-something with chest pain. Is there OMI? And what is the rhythm?
Dr. Smith's ECG Blog
MARCH 22, 2024
Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown: What do you think? What do you think? This was the cost of preventing infarction of the anterior wall.)
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Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.
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. Old ‘NSTEMI’ A history of coronary artery disease and a stent to the same territory further increases pre-test likelihood of acute coronary occlusion, including in-stent thrombosis.
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Acute chest pain in a patient with LVH and known coronary disease. What does the ECG show?
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. The pain did not resolve with NTG, and so he went to emergent angiography: 1. LAD: severe in-stent restenosis in the mid (80%) and distal (90%) segment and diffuse disease distally.
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50-year old with chest pain, “no ischemic changes”
Dr. Smith's ECG Blog
DECEMBER 29, 2023
Written by Jesse McLaren A previously healthy 50 year-old presented with 24 hours of intermittent exertional chest pain, radiating to the arms and associated with shortness of breath. In a previously healthy patient with new and ongoing chest pain, this is concerning for acute occlusion of the first diagonal artery.
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A man in his 60s with acute chest pain
Dr. Smith's ECG Blog
FEBRUARY 6, 2023
Sent by anonymous, written by Pendell Meyers A man in his 60s presented with acute chest pain with diaphoresis. The Importance of the History: As noted above — the onset of chest pain in today's case was acute. He had received aspirin and nitroglycerin by EMS, with some improvement. His vitals were within normal limits.
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Severe Chest Pain on ED Arrival, after Wellens' waves Seen on Prehospital ECG
Dr. Smith's ECG Blog
MARCH 13, 2023
A 40-something woman called 911 in the middle of the night for Chest pain that was intermittent. On arrival, she complained of severe pain. The medics had recorded this ECG and were uncertain whether it was recorded during chest pain: Let's get a better image with use of the PM Cardio app : What do you think?
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Completely Wireless: First Concomitant Dual Chamber Leadless Pacemaker and Subcutaneous Defibrillator Implant
HeartRhythm
SEPTEMBER 8, 2024
He had minimal in-stent restenosis on angiography but had only minimal cardiac enzyme elevation and did not have antecedent chest pain before either of his events. While in the hospital, he had witnessed ventricular fibrillation (VF) arrest for which he received external defibrillation.
A man in his 60s with acute chest pain and high voltage
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.
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Abnormal echocardiographic finding mimicking paracardiac cystic lesion
Heart BMJ
AUGUST 14, 2024
Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.
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A 50-something with acute chest pain, a computer "Normal" ECG, and a HEART score of 3 (low risk)
Dr. Smith's ECG Blog
APRIL 29, 2023
A 50-something with no previous cardiac history and no risk factors presented to the ED with acute chest pain (pressure) that radiated to the left arm. It was stented with good results. An ECG was immediately recorded: Computer read: Normal ECG What do you think? There is ST depression in V1-V3.
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A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?
Dr. Smith's ECG Blog
MAY 23, 2023
Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset.
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Opiate overdose, without chest pain or shortness of breath. Cognitive dissonance.
Dr. Smith's ECG Blog
NOVEMBER 1, 2022
The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction. In the setting of prior stenting and reduced left ventricular ejection fraction, would pursue a heart team revascularization approach Syntax score 28.5, Pericarditis would be even more unlikely in someone without chest pain.
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A man with chest pain off and on for two days, and "No STEMI" at triage.
Dr. Smith's ECG Blog
JUNE 19, 2023
The patient’s chest pain spontaneously resolved before he was evaluated and has a repeat ECG obtained at 22:12 obtained shown below. In context, of course, it is clear that the patient is reperfusing, as pain has dissipated and the diagnostic findings of OMI have become more nonspecific. This ECG is more difficult.
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Acute Dyspnea and Right Bundle Branch Block
Dr. Smith's ECG Blog
NOVEMBER 17, 2023
It is of an elderly woman who complained of shortness of breath and had a recent stent placed. Also, we know the patient had a stent. Finally, the presentation is dyspnea, not chest pain. A few days before that, she had had an LAD stent for LAD occlusion. I was texted this ECG just as I was getting into bed.
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A man in his 70s with acute chest pain and paced rhythm.
Dr. Smith's ECG Blog
MAY 8, 2023
Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent.
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Study Suggests Most Patients with Acute Coronary Syndromes Can Safely Stop Aspirin One Month After Percutaneous Coronary Intervention
DAIC
APRIL 8, 2024
The study focused on patients who underwent PCI for acute coronary syndromes (ACS)—life-threatening conditions which include heart attacks and chest pain caused by decreased blood flow to the heart—with stents containing drugs to prevent further plaque buildup. Stents were supplied by Medtronic Corp. Minnesota, U.S.)
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Preventive Percutaneous Coronary Intervention for High-Risk Coronary Plaques Reduces Cardiac Events
DAIC
APRIL 11, 2024
At two years, people who underwent preventive PCI were 89% less likely to experience the composite primary endpoint of cardiac death, heart attack in the target vessel, revascularization due to ischemia in the target vessel or hospitalization for unstable or progressive chest pain compared with people who received medications alone.
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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?
Dr. Smith's ECG Blog
MAY 30, 2023
A 50-something man presented in shock with severe chest pain. Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. His prehospital ECG was diagnostic of inferior posterior OMI. The patient was in clinical shock with a lactate of 8. He appeared gray in color, with cool skin.
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A woman in her 50s with chest pain and lightheadedness and "anterior subendocardial ischemia"
Dr. Smith's ECG Blog
JULY 30, 2023
Written by Pendell Meyers A woman in her 50s presented with acute chest pain and lightheadedness since the past several hours. She was taken to cath and found to have total mid RCA occlusion, TIMI 0 flow, stented with excellent result. Here is her triage ECG during active symptoms: What do you think?
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A 40 year old man with chest pain since last night
Dr. Smith's ECG Blog
JULY 11, 2019
Written and submitted by Ashley Mogul, with edits by Pendell Meyers and Steve Smith A man in his 40s with recent smoking cessation but otherwise no known past medical history presented due to chest pain since the previous evening. The pain has been constant and associated with vomiting and diaphoresis.
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A man in his 40s with chest pain and syncope after cocaine use
Dr. Smith's ECG Blog
JULY 19, 2019
Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). The patient was still with ongoing chest pain at the time ECG #1 was done.
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Chest pain in a 30-something: Is it Normal variant STE or OMI? Get the prior ECG, and don't trust Point of Care troponin assays!
Dr. Smith's ECG Blog
OCTOBER 2, 2021
Submitted by Benjamin Garbus, MD with edits by Bracey, Meyers, and Smith A man in his early 30s presented to the ED with chest pain described as an “explosion" of left chest pressure. Today’s pain lasted around 20 mins, but was severe enough that the patient called EMS. Triage EKG: What do you think?
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Chest Pain and Right Bundle Branch Block
Dr. Smith's ECG Blog
NOVEMBER 19, 2014
A male in late middle age with a history of RCA stent 8 years prior complained of chest pain. EMS recorded the following ECG: What do you see? The computer read "Right Bundle Branch Block" There is RBBB and LAFB, which can make it difficult to see the end of the QRS.
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Proportionality and Serial ECGs Make the Diagnosis. What does the Queen say?
Dr. Smith's ECG Blog
SEPTEMBER 29, 2023
A 60-something woman called EMS for chest pain. link] Clinical Course I don't know if the medics noticed these ECG findings or not, but if not, they recognized the value of serial ECGs in a patient with chest pain. The medics administered aspirin (no Nitroglycerine), and the pain resolved. #5: mm in V2 and 0.65
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?
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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If you had recorded an ECG during chest pain, what would it have shown?
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.
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Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.
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.
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