Dr. Smith's ECG Blog

APRIL 6, 2024

A young woman presented with acute chest pain. This case came from a friend whose sister was the patient. She knew I was interested in ECGs, so she took a photo of this one. This was her presenting ECG: What do you think? This is clearly Brugada phenotype. There is downsloping ST Elevation in V1 and V2.

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Chest Pain STEMI Hospital 94

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. See some relevant cases below: Chest pain with anterior ST depression: look what happens if you use posterior leads.

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Chest Pain STEMI Myocardial Infarction Ischemia 83

Dr. Smith's ECG Blog

APRIL 9, 2024

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. How would you assess this ECG? What is your next step?

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Chest Pain Pericarditis Blog Risk Factors 82

Heart BMJ

APRIL 15, 2024

Clinical introduction A man in his 40s with a history of hyperlipidaemia presented with intermittent, dull left-sided chest pain for 2 weeks that was not consistently exertional. Physical examination, an ECG, basic laboratories and a chest X-ray were unremarkable. He did not smoke or use alcohol or illicit drugs.

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Chest Pain Echocardiogram Angina Laboratory 52

Dr. Smith's ECG Blog

MARCH 9, 2024

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. Due to the chest pain radiating into the patient's back, the ER physician ordered CTA chest to rule out aortic dissection. He had associated nausea, vomiting, and dyspnea.

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Chest Pain Pericarditis Aortic Echocardiogram 100

Dr. Smith's ECG Blog

MARCH 13, 2024

Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It started while he was at rest after finishing a workout.

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Chest Pain Angina Echocardiogram Myocardial Infarction 78

JAMA Cardiology

FEBRUARY 27, 2024

This prespecified secondary analysis of the Diagnostic Imaging Strategies for Patients With Stable Chest Pain and Intermediate Risk of Coronary Artery Disease (DISCHARGE) randomized clinical trial investigates the association of age with clinical outcomes after computed tomography and coronary angiography in stable chest pain.

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Chest Pain Coronary Artery Disease Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 15, 2023

Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." K en G rauer gives a thorough explanation here: A 60 year old with chest pain == MY Comment , by K EN G RAUER, MD ( 9/15 /2023 ): == The 1st time that I saw APTA ( A rterial P ulse T ap A rtifact ) — I did not know what it was. That is not a STEMI.

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Chest Pain Diabetes STEMI Blog 118

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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Chest Pain Ischemia Myocardial Infarction Ultrasound 96

ECG Cases

DECEMBER 20, 2022

Jesse McLaren discusses some key aspects of cocaine chest pain ECG interpretation in this month's blog including: Patients with cocaine-associated chest pain require benzodiazepines +/- nitroglycerine for symptom relief, aspirin and ECG to look for signs of occlusion and reperfusion.

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Chest Pain STEMI Blog Ischemia 52

American College of Cardiology

MARCH 12, 2024

The goal of the DISCHARGE trial was to evaluate computed tomography (CT) compared with invasive coronary angiography among patients with stable chest pain and intermediate pretest probability of obstructive coronary artery disease.

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Coronary Artery Disease Chest Pain Article 62

Dr. Smith's ECG Blog

JUNE 21, 2023

Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. The primary care physician there evaluated this patient and deemed the chest pain to be due to gastrointestinal causes. The ECG was also interpreted as normal by the primary care physician.

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Chest Pain Cardiac Arrest STEMI Defibrillator 93

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 Myocardial Infarction Angina Anatomy 110

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. So a patient with high pretest probability (prior CABG with new chest pain), had new ECG changes showing posterior OMI.

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Chest Pain STEMI Atrial Flutter Ischemia 103

Dr. Smith's ECG Blog

NOVEMBER 27, 2023

Written by Jesse McLaren A 45 year old presented with two weeks of recurring non-exertional chest pain, now constant for an hour. Because of the ECG changes in a patient with chest pain, and with inferolateral hypokinesis on POCUS, the cath lab was activated. Below is old and then new ECG (old on top; new below).

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Chest Pain STEMI Ischemia Anatomy 80

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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Chest Pain STEMI Ischemia Nursing 83

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?

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Chest Pain Bradycardia STEMI Ischemia 102

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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Chest Pain Myocardial Infarction Stents Stent 80

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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Chest Pain STEMI Myocardial Infarction Electrocardiogram 66

American College of Cardiology

FEBRUARY 1, 2024

Using computed tomography angiography (CTA) to evaluate stable chest pain patients was associated with a higher likelihood of revascularization when compared to other imaging modalities or no testing, according to a new study being presented at ACC’s Cardiovascular Summit 2024, taking place Feb. 1-3 in Washington, D.C.

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Chest Pain Article 48

Medical Xpress - Cardiology

FEBRUARY 1, 2024

Previous studies have found less than 40% of patients with stable chest pain undergoing invasive coronary angiography are found to have obstructive coronary artery disease. Recent randomized clinical trials have demonstrated a benefit to using computed tomography angiography (CTA) first in evaluation of these patients.

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Chest Pain Coronary Artery Disease Research 45

Open Heart

JUNE 29, 2023

Contemporary data on recurrent AMI and its association with return emergency department (ED) visits for chest pain are needed. Methods This Swedish retrospective cohort study linked patient-level data from six participating hospitals to four national registers to construct the Stockholm Area Chest Pain Cohort (SACPC).

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Chest Pain Myocardial Infarction Hospital 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. The patient has a history of CABG so some of these changes could be old, but with ongoing chest pain and bradycardia in a high risk patient this is still acute OMI until proven otherwise. HR 40, BP 135/70, RR16, O2 100%.

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Chest Pain STEMI Bradycardia Myocardial Infarction 60

Frontiers in Cardiovascular Medicine

DECEMBER 13, 2023

Methods We retrospectively analyzed the measurements at rest for 191 patients with acute chest pain (ACP) magnetocardiographically. The individual relationship between fatal arrhythmias and cardiac function abnormalities in predicting cardiac death risk has rarely been explored.

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Chest Pain Cardiac Arrest Public Health Defibrillator 64

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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Chest Pain Physiology Stents Stent 52

The British Journal of Cardiology

MARCH 7, 2024

The National Institute for Health and Care Excellence (NICE) advise against routine testing for coronary artery disease (CAD) in patients with non-anginal chest pain (NACP).

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Coronary Artery Disease Chest Pain Risk Factors Hypertension 52

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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Chest Pain Myocardial Infarction Angioplasty Thrombosis 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chest pain. He was eating lunch when he had sudden onset chest pressure, 9/10, radiating to his back, with sweating and numbness in both hands.

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Chest Pain Tachycardia STEMI Blog 107

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you manage the patient?

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Chest Pain Blog STEMI 118

Dr. Smith's ECG Blog

JANUARY 15, 2024

They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They described the chest pain as severe, crushing, and non-radiating. Altogether, this strongly suggests inferolateral OMI, particularly in a patient with acute chest pain.

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Chest Pain Blog Critical Care Arrhythmia 61

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 Exercise Blog 73

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. PEARL: Most patients who present with new chest pain + ECG changes + positive troponin — will not need Cardiac MRI. This was sent to me by a partner: "Curious what you think of this one we had overnight.

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Chest Pain Pericarditis Blog Cardiomyopathy 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! —

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Chest Pain STEMI Myocardial Infarction Blog 52

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. He was sweaty, clammy and had accompanying breathlessness. There was no antecedent angina. There was no medical history and he was not on any medical treatment.

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Chest Pain Angina Ultrasound Plaque 40

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

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Chest Pain STEMI Blog Pericarditis 52

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.

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Chest Pain Ischemia Stenosis Tachycardia 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?

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Chest Pain Coronary Angiogram Circulation Electrocardiogram 52