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?

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 12, 2013

A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. He had no chest pain. He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema.

STEMI 52

STEMI Pulmonary Stents Stent 52

Dr. Smith's ECG Blog

OCTOBER 1, 2023

A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think? Gallbladder ultrasound was negative for stones.

Stents 127

Stents Stent STEMI Physiology 127

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart attacks 120

Dr. Smith's ECG Blog

OCTOBER 24, 2013

He underwent coronary stenting (uncertain which artery). There is no way to tell the difference between GI etiology of chest pain and MI. Such T-waves are almost always reciprocal to ischemia in the region of aVL (although aVL looks n ormal here) , and in a patient with chest pain are nearly diagnostic of ischemia.

Cardiac Arrest 52

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 6, 2010

He had no previous history of CAD, and presented with very typical waxing and waning chest pain, much worse with exertion but also present at rest and on presentation, though his pain was minimal at the time of the ECG. Two stents were placed. I saw this 59 year old male 3 weeks ago. Blood pressure was 150/80.

STEMI 52

STEMI Chest Pain Ultrasound Blood Pressure 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. However, this is not SVT. What to do now?

Tachycardia 139

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 139

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chest pain. So the RCA was stented.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 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

Dr. Smith's ECG Blog

JANUARY 5, 2024

The patient said his chest pain was 4/10, down from 8/10 on presentation. On intravascular ultrasound (IVUS), the mid RCA plaque was described as "cratered, inflamed, and bulky," and the OM plaque was described as "bulky with evidence of inflammation and probably ulceration." Repeat hsTnI was 183 ng/L, up from 26 ng/L.

Angina 121

Angina Plaque Document Stents 121

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. Fortunately, this operator used intravascular ultrasound (IVUS). The operator documented thoughtful consideration of risks and benefits of stent placement. She took an oxycodone and called EMS. I sent this to Drs.

Plaque 66

Plaque Stents Stent Chest Pain 66

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. EMS gave 324 mg aspirin and 3 sublingual NTG, which the patient stated reduced the substernal chest pain from an 8/10 to 4/10. This was a point of care ultrasound, not a bubble contrast echo.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

Dr. Smith's ECG Blog

FEBRUARY 14, 2009

This is the EKG of a previously healthy 40 year old man with one hour of chest pain and profound weakness and sense of "doom". A bedside ultrasound revealed a possible anterior wall motion abnormality. There was an LAD occlusion that was opened and stented. Click here for an even better case of this phenomenon.

Chest Pain 52

Chest Pain Ultrasound STEMI Stents 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

This is the initial ED ECG of a 46 year old male with chest pain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 ng/ml) A 45 year old male called 911 for chest pain: The QTc was 400 ST Elevation at 60 ms after the J-point in lead V3 = 3.5 100% LAD occlusion. He underwent CABG. QRS V2 = 15.5

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. This is written by Willy Frick, an amazing cardiology fellow in St.

Plaque 127

Plaque Angina Blog Stent 127

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. Case 3 : Male in 30's with chest pain, cough, and fever. A bedside ultrasound was done by the emergency physician, using Speckle Tracking. A male in late middle age with a history of RCA stent 8 years prior complained of chest pain.

STEMI 40

STEMI Chest Pain Cardiac Arrest Stents 40

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

No chest pain. His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. Later on during the night of his admission he had a short episode of chest pain that resolved with sublingual nitroglycerin.

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Case A 47 year old male called 911 for severe chest pain. It was opened and stented. A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chest pain with radiation to the anterior neck, with associated nausea. Culprit, stented) 3. He was clammy and looked unwell.

Ischemia 40

Ischemia Chest Pain STEMI Stenosis 40

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. It was stented. Serial ECGs correlated to the presence ( and severity ) of chest pain — often reveal the status of the "culprit" artery (ie, occluded, reopened, reoccluded ).

STEMI 40

STEMI Chest Pain Hospital Risk Factors 40

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. It was stented. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, QTc = 377 by computer 4-variable formula value = 16.2, There was good flow. A 0-hour troponin I, drawn 2 hours after symptoms onset , was below the level of detection (LoD, less than 0.010 ng/mL.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

APRIL 8, 2016

A late middle-aged man presented with one hour of chest pain. Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. This was stented. Most recent echo showed EF of 60%. He also had a history of chronic kidney disease, stage III. He had recently had a NonSTEMI.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

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 110

Chest Pain Ischemia Stents Stent 110

Frontiers in Cardiovascular Medicine

MARCH 5, 2025

BackgroundPercutaneous coronary intervention (PCI) through the aorto-ostial coronary stent that is protruding into the aorta remains a technical challenge because of the poor coaxial alignment of the guiding catheter and the inability to advance the guidewire into the distal vessel through the stent's central lumen.

Stent 52

Stent Stents Chest Pain Myocardial Infarction 52