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 114

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 101

Chest Pain STEMI Ischemia Myocardial Infarction 101

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.

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Chest Pain Outcomes 77

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.

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Chest Pain Heart Attack Heart attacks Research 91

All About Cardiovascular System and Disorders

APRIL 10, 2024

It is not always possible to be certain about the origin of chest pain just by its characteristics as the variation between individuals is quite a bit. A medical opinion should be sought in case of any significant chest pain so that important ailment is not missed. A pain lasting more than 30 minutes is usual.

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Chest Pain Angina Exercise Pericarditis 52

Med Page Today

MAY 19, 2024

(MedPage Today) -- PARIS -- Whether a person had chest pains resolved by angioplasty hinged on the nature, not the severity, of their presenting symptoms, an ORBITA-2 analysis showed. Investigators found two groups more likely to benefit from.

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Chest Pain Angina Angioplasty 57

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?

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Chest Pain Critical Care STEMI Stents 112

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 99

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 116

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 92

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 134

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

Dr. Smith's ECG Blog

JUNE 13, 2024

Click here to sign up for Queen of Hearts Access Case A 58-year-old woman presented to the ED with burning chest pain that started 2-3 hours earlier while sitting on a porch swing. In any case, it is diagnostic of OMI in a chest pain patient. But there is also perhaps some STD in inferior leads -- this would support LAD.

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Chest Pain Document STEMI Defibrillator 92

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 96

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 50

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

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 115

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 98

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 95

Dr. Smith's ECG Blog

JUNE 19, 2024

Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. He described his chest pain as pleuritic and reported that it started the day prior while swinging a golf club. His pain suddenly became much worse in the ED and he became acutely diaphoretic, dizzy, and hypotensive.

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Chest Pain Pericarditis Pacemaker STEMI 61

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 115

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

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 96

Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Here’s the EMS ECG, digitized with PM cardio. What do you think? There’s sinus arrhythmia with normal conduction, normal axis and normal voltages. There’s loss of R waves in V2-3 with hyperacute waves V1-5.

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Chest Pain STEMI Blog Arrhythmia 67

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 114

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 71

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 Anatomy Angina 119

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 68

Dr. Smith's ECG Blog

JUNE 23, 2024

He did not remember whether he had experienced any chest pain. Within a few days, the patient was extubated and was neurologically intact. However, he did not remember much from the day of the arrest. At his family's request, he was transferred to a hospital closer to his home to continue care. He was admitted to cardiology.

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Chest Pain Cardiac Arrest Sudden Cardiac Death Stents 115

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 49

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 126

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

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

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 130

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 Cardiac Function 64

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