ECG Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.

Chest Pain 135

Chest Pain Blog Embolism Pulmonary 135

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

2 middle aged males presented with chest pain. Which had the more severe chest pain at the time of the ECG? Patient 2 at the bottom with a very subtle OMI complained of 10/10 chest pain at the time the ECG was recorded. 414 patients were included in the analysis.

Chest Pain 122

Chest Pain STEMI Myocardial Infarction Hospital 122

Dr. Smith's ECG Blog

JANUARY 24, 2025

The patient received three nitroglycerin tablets with significant "improvement" in his chest pain. Improved chest pain is unresolved chest pain. I am commonly told, and I commonly read in the chart that chest pain is resolved. It is not enough for the chest pain to be "much better."

Chest Pain 128

Chest Pain STEMI Risk Factors Coronary Artery Disease 128

Dr. Smith's ECG Blog

OCTOBER 3, 2024

I assumed it was a patient with acute chest pain. It was a man in his 30s with chest pain. This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. What do you think, Steve? Real or just fake?" What do YOU think? It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL.

Chest Pain 127

Chest Pain Blog Myocardial Infarction 127

Dr. Smith's ECG Blog

JUNE 7, 2024

Written by Jesse McLaren A 45-year-old presented with 24 hours of intermittent chest pain. On it’s own this is nonspecific, but in the right context this could be diagonal occlusion (if active chest pain) or infero-posterior reperfusion (if resolved chest pain). #2 Can you guess the sequence?

Chest Pain 115

Chest Pain STEMI Outcomes Document 115

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.

Chest Pain 138

Chest Pain Diabetes STEMI Blog 138

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?

Chest Pain 119

Chest Pain STEMI Pericarditis Stents 119

Dr. Smith's ECG Blog

SEPTEMBER 1, 2023

A 50-something male had onset of chest pain 1 hour prior to ED arrival. Endorses some associated SOB, but denies back pain, fever, cough, chills, leg swelling, or other new symptoms. Always get serial ECGs in a patient with acute chest pain. It is constant, 9/10, left-sided CP that radiates into left arm and jaw.

Chest Pain 131

Chest Pain STEMI Stenosis Myocardial Infarction 131

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.

Chest Pain 125

Chest Pain STEMI Hospital 125

Dr. Smith's ECG Blog

MAY 27, 2024

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chest pain as a “STEMI equivalent”[3] 3. But are there any other signs of Occlusion MI? Conduction disorders in the setting of acute STEMI.

Chest Pain 126

Chest Pain STEMI Myocardial Infarction Ischemia 126

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.

Chest Pain 113

Chest Pain STEMI Ischemia Myocardial Infarction 113

American College of Cardiology

NOVEMBER 5, 2024

ACC's Chest Pain Center Accreditation is designed to help facilities to establish consistent, high-quality processes for the most efficient and effective acute coronary syndrome (ACS) care.

Chest Pain 40

Chest Pain Article 40

JAMA Cardiology

DECEMBER 17, 2024

A man in his mid-50s presented with chest pain lasting 30 minutes. The initial electrocardiogram showed type A preexcitation syndrome, with obvious ST-segment depression in leads V3 through V5 and positive delta wave. What would you do next?

Chest Pain 79

Chest Pain Electrocardiogram 79

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).

Chest Pain 113

Chest Pain STEMI Ischemia Anatomy 113

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.

Chest Pain 112

Chest Pain Angina Echocardiogram Myocardial Infarction 112

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.

Chest Pain 120

Chest Pain Pericarditis Aortic Echocardiogram 120

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?

Chest Pain 102

Chest Pain STEMI Bradycardia Stents 102

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?

Chest Pain 110

Chest Pain Pericarditis Blog Risk Factors 110

Dr. Smith's ECG Blog

AUGUST 16, 2024

Written by Pendell Meyers A man in his 60s presented with acute chest pain and normal vital signs. Here is his triage ECG: What do you think? The ECG shows massively hyperacute T waves of LAD OMI, plus WPW. V3-V5 also have the depressed HATW takeoff which qualifies them as the rare de Winter subtype of HATWs.

Chest Pain 114

Chest Pain STEMI Blog 114

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.

Chest Pain 133

Chest Pain Tachycardia STEMI Blog 133

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.

Chest Pain 98

Chest Pain Cardiac Arrest STEMI Defibrillator 98

Medical Xpress - Cardiology

MARCH 29, 2024

Future heart attacks could be better prevented in people visiting their GP with unexplained chest pain, after Keele researchers developed the clearest picture yet of the factors that put them at higher risk. The research is published in the European Journal of Preventive Cardiology.

Chest Pain 91

Chest Pain Heart attacks Heart Attack Research 91

Dr. Smith's ECG Blog

JANUARY 29, 2024

This was sent by Sam Ghali @EM_RESUS A 44 year old man presented with chest pain The tech came running with the ECG as the computer called "STEMI!" What do you think? Sam sent this to me and asked: "What do you think, Steve?" My answer: --Tough one! --But

Chest Pain 102

Chest Pain STEMI Blog Outcomes 102

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?

Chest Pain 133

Chest Pain Blog STEMI 133

The New England Journal of Medicine

JUNE 6, 2025

A 76-year-old retired cardiovascular nurse presented to the ED with 2 hours of chest pain triggered by severe emotional distress and associated with changes in the electrocardiogram on her smartwatch.

Chest Pain 66

Chest Pain Electrocardiogram Nursing 66

Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation. For 2 of the 3 patients — the cath lab was activated based on the ECG.

Chest Pain 106

Chest Pain Ischemia Pericarditis Tachycardia 106

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.

Chest Pain 122

Chest Pain Ischemia Myocardial Infarction Ultrasound 122

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.

Chest Pain 117

Chest Pain STEMI Atrial Flutter Ischemia 117

JAMA Cardiology

MAY 13, 2025

This 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 if computed tomography used in patients with stable chest pain provides comparable long-term health-related quality of life benefits and chest pain reduction (..)

Chest Pain 66

Chest Pain Coronary Artery Disease Quality of Life 66

Dr. Smith's ECG Blog

FEBRUARY 14, 2024

A 41-year-old male who presents to the emergency department with chest pain. Patient reports approximately 2 hours prior to arrival he developed a sharp chest pain that radiates into his left arm and left lower leg. Describes the radiating pain as numbness/tingling. No shortness of breath. No recent travel.

Chest Pain 113

Chest Pain Angina Ischemia Outcomes 113

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.

Chest Pain 114

Chest Pain Myocardial Infarction Stents Stent 114

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. Here is the ED ECG (a photo of the paper printout) What do you think?

Chest Pain 117

Chest Pain Aneurysm Stents Stent 117

American College of Cardiology

MARCH 25, 2024

What is the validity the American College of Cardiology Expert Consensus Decision Pathway (ACC Pathway) for chest pain in a multisite US cohort?

Chest Pain 67

Chest Pain Article 67

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. 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?

Chest Pain 118

Chest Pain Critical Care STEMI Stents 118

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?

Chest Pain 117

Chest Pain STEMI Bradycardia Ischemia 117

Med Page Today

MAY 23, 2024

(MedPage Today) -- For lower-risk patients with acute myocardial injury already ruled out for their chest pain, an increase in referrals for noninvasive cardiac testing (NICT) was not associated with improved outcomes, a retrospective cohort study.

Chest Pain 80

Chest Pain Outcomes 80

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.

Chest Pain 121

Chest Pain Myocardial Infarction Anatomy Angina 121