Remove Hypertension Remove Pericarditis Remove STEMI
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Acute chest pain and ST Elevation. CT done to look for aortic dissection.

Dr. Smith's ECG Blog

Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. What do you think?

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Why the sudden shock after a few days of malaise?

Dr. Smith's ECG Blog

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). As already mentioned, this patient could have post-infarction regional pericarditis from a large completed MI. Sinus tachycardia has many potential causes.

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What would you do with acute chest pain and this ECG? You might see what the Queen thinks.

Dr. Smith's ECG Blog

Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. His EKG with worse pain now shows enough ST elevation to meet STEMI criteria. The undergraduate continues: This new EKG pattern is more suggestive of acute pericarditis. This is typical of pericarditis.

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Sometimes even ST Elevation meeting criteria is not enough to be convincing

Dr. Smith's ECG Blog

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. Such an out-of-proportion STE is virtually never seen in pericarditis. Written by Emre Aslanger. Emre is a new Editor of the Blog.

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Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." St depression in lead AVL differentiates inferior st-elevation myocardial infarction from pericarditis. The case continues.

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

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. He had multiple cardiac arrests with ROSC regained each time.