Dr. Smith's ECG Blog

JANUARY 6, 2023

Submitted and written by Anonymous, edits by Meyers and Smith A 50s-year-old patient with no known cardiac history presented at 0045 with three hours of unrelenting central chest pain. The pain was heavy, radiated to her jaw with an associated headache. Triage VS: 135/65 mmHg, 95 bpm, 94% on room air, 16/min, 98.6 Abstract 556.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

APRIL 25, 2023

Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. No pericardial effusion on ultrasound." PEARL: Most patients who present with new chest pain + ECG changes + positive troponin — will not need Cardiac MRI. What do you think?

Chest Pain 52

Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

[link] A 30 year-old woman was brought to the ED with chest pain. She had given birth a week ago, and she had similar chest pain during her labor. She attributed the chest pain to anxiety and stress, saying "I'm just an anxious person." Type 2 is more difficult to appreciate on angiography than type 1.

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 15, 2021

An 80-something year old man with history of metastatic cancer had acute onset of chest pain and called 911. There is no typical evolution of MI (so BOTH EKG evolution, and troponin, proves there was no acute MI) 2 weeks later, the patient present with acute chest pain again. He ruled out for MI by troponins again.

Chest Pain 40

Chest Pain Ultrasound Pericarditis STEMI 40

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. J Am Heart Assoc.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?

Chest Pain 40

Chest Pain Ischemia Aortic Aortic valve 40

Heart BMJ

JANUARY 29, 2024

Clinical introduction Vignette A man in his 40s presented to our emergency department with sudden onset of severe central chest pain radiating to his left arm. Intravascular ultrasound was also performed ( figure 1B ). He was sweaty, clammy and had accompanying breathlessness. There was no antecedent angina. fig loc="float".

Chest Pain 40

Chest Pain Angina Ultrasound Plaque 40

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.

Chest Pain 125

Chest Pain Blood Pressure Ischemia STEMI 125

Dr. Smith's ECG Blog

JUNE 14, 2017

There was apparently no syncope and he had no bony injuries, but he did complain of left sided chest pain. His chest was tender. A bedside cardiac ultrasound was normal. An ECG was recorded: Avinash was understandably confused by this ECG. He wrote: "ECG 1 - shows wide ???IVCD IVCD type rhythm ??

Chest Pain 52

Chest Pain Congenital Heart Disease Article Congenital 52

Dr. Smith's ECG Blog

MARCH 26, 2024

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. Chest pain, SOB, Precordial T-wave inversions, and positive troponin.

Chest Pain 68

Chest Pain Embolism Pulmonary Ischemia 68

Dr. Smith's ECG Blog

JANUARY 10, 2020

He presented to the ED because he developed sudden severe, sharp, pleuritic (but not positional), substernal and left mid to lower chest pain. Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality.

Chest Pain 40

Chest Pain Pericarditis Ultrasound Download 40

Dr. Smith's ECG Blog

MARCH 21, 2011

He complained of chest pain. The physician (one of our fine EM residents) caring for the patient did an immediate bedside ultrasound. This 74 yo male had just returned to his unit bed after successful PTCA of tight lesions of the first diagonal and obtuse marginal coronaries. This ECG was recorded. The previous is below.

STEMI 40

STEMI Ultrasound Chest Pain 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". Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Fluids were started. Is is sinus?

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Frontiers in Cardiovascular Medicine

OCTOBER 14, 2024

This paper reports a case of an elderly female patient who experienced severe chest pain and syncope during acupuncture therapy, subsequently diagnosed with traumatic hemopericardium and acute cardiac tamponade, complicated by cardiogenic shock. Under ultrasound guidance, pericardial puncture and drainage were successfully performed.

Cardiogenic Shock 52

Cardiogenic Shock Chest Pain Ultrasound Hemorrhage 52

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

He was given aspirin and sublingual nitro and the pain resolved. Bedside cardiac ultrasound with no obvious wall motion abnormalities. Another ECG was recorded after the nitroglycerine and now without pain: All findings are resolved. He had a previous ECG on file: Proving the findings are new The cath lab was activated.

Ischemia 121

Ischemia Plaque Stenosis Myocardial Infarction 121

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. But the History in today's case was acute shortness of breath with dizziness and lightheadedness — and, essentially without chest pain!

Cardiogenic Shock 127

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 127

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

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? Ken (below) is appropriately worried about pulmonary embolism from the ECG. Here is my interpretation: There is sinus rhythm with RBBB.

Aneurysm 124

Aneurysm Stents Stent Chest Pain 124

Dr. Smith's ECG Blog

OCTOBER 24, 2013

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. An emergency cardiac ultrasound could be very useful.

Cardiac Arrest 52

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia 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. My opinion was that it was not a cath lab case, but I did suggest they do a bedside ultrasound to look for an anterior wall motion abnormality. I had not seen the cardiac ultrasounds at this time.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

The patient had experienced one month of chest pains, coughing and hemoptysis symptoms. Ultrasound showed no thrombosis in the veins of both lower limbs. After treatment, the patient's chest pain symptoms were relieved, and there were no symptoms such as difficulty breathing.

Embolism 40

Embolism Pulmonary Chest Pain Thrombosis 40

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. I saw this 59 year old male 3 weeks ago. Blood pressure was 150/80.

STEMI 52

STEMI Chest Pain Ultrasound Blood Pressure 52

Frontiers in Cardiovascular Medicine

OCTOBER 7, 2024

Two months later, cardiac ultrasound showed pericardial fluid. Postoperative patient experienced chest pain, right shoulder and upper limb swelling and pain. Pain management and anticoagulant therapy were administered. Then monthly follow-up echocardiography was performed.

Chest Pain 52

Chest Pain Ultrasound Cancer Outcomes 52

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. Vitals were HR 58 BP 167/70 R20 sat 96%.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 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

APRIL 12, 2013

He had no chest pain. The computer read is: **Acute MI ** The protocol for prehospital activation in the EMS system that this patient presented to requires 2 elements: 1) Chest pain 2) A computer read of **Acute MI ** Only 1 of 2 was present, so there was no prehospital activation. The patient was transported to the ED.

STEMI 52

STEMI Pulmonary Stents Stent 52

Dr. Smith's ECG Blog

JUNE 28, 2023

He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded. The bedside ultrasound (video not available) reportedly showed only a slightly reduced LV function. The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm. Here is the ECG: What do you think?

Tachycardia 98

Tachycardia Ultrasound Heart Disease Atrial Fibrillation 98

Dr. Smith's ECG Blog

MARCH 6, 2023

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation? However, in the context of the first ECG and the waning chest pain, this is diagnostic of reperfusion. Due to the severity of the pain and the high BP, they obtained an aortic dissection CT.

Chest Pain 52

Chest Pain STEMI Stenosis Blog 52

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.

Pericarditis 52

Pericarditis Chest Pain Aortic Blog 52

Dr. Smith's ECG Blog

APRIL 20, 2018

female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chest pain for the past four hours. While she was in her bed at home, she had sudden onset of left sided chest pain that radiated to her shoulder. The pain was pleuritic, without nausea or diaphoresis.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

Dr. Smith's ECG Blog

OCTOBER 26, 2010

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chest pain. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded.

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

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

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

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

JUNE 18, 2011

3 hours prior to calling 911 he developed typical chest pain. 1.196 x STE60 in V3 in mm) + (0.059 x computerized QTc) - (0.326 x RA in V4 in mm) Third, one can do an immediate cardiac ultrasound. Medics gave him nitroglycerine sublingual and his pain resolved. greater than 23.4 is likely anterior STEMI).

STEMI 52

STEMI Pericarditis Hospital Aneurysm 52

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. On medic arrival, she walked out of the house in no distress, but was diaphoretic.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 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

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