Dr. Smith's ECG Blog

JUNE 1, 2012

This was a middle aged female with a h/o CAD who presented to the ED by EMS sudden onset of central chest pressure 45 min prior to ED arrival with associated diaphoresis and SOB.  There is LVH and there are ST-T abnormalities (large inferior T-waves and ST elevation, with reciprocal findings in aVL).

STEMI 52

STEMI CAD ED EMS 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc. Academic Emergency Medicine 27(S1): S220; May 2020.

ACS 85

ACS Coronary ALS CAD 85

Dr. Smith's ECG Blog

JANUARY 20, 2024

Cardiology refused to be the admitting physician because it was "NSTEMI", and forced the ED physician to admit the patient to the hospitalist. Of course, there was terrible boarding and the patient was considered non-emergent (NSTEMI), and so could not leave the ED for some time. Scattered other nonobstructive CAD.

STEMI 110

STEMI CAD ED ALS 110

Dr. Smith's ECG Blog

JANUARY 9, 2023

No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. My Comment by K EN G RAUER, MD ( 1/9 /2023 ): = “ Treat the patient — Not the age of the patient”. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath.

Coronary 52

Coronary STEMI Heart Attack OR 52

Dr. Smith's ECG Blog

JUNE 2, 2023

Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED. They are rare and hard to find in normal practice in the ED. She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? There is mild-moderate tricuspid valve regurgitation.

ED 71

ED OR ALS CAD 71

ACEP Now

APRIL 4, 2024

A 59-year-old male with a past medical history of a repaired ventricular septal defect (VSD), dextrocardia, hypertension, hyperlipidemia, and current smoker presented to the emergency department (ED). This patient had known coronary artery disease (CAD), and previously required drug eluting stents to the obtuse marginal and diagonal arteries.

Coronary 40

Coronary STEMI CAD Emergency Department 40

Dr. Smith's ECG Blog

JULY 22, 2023

An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. QOH Interpretation: The initial troponin I (older generation) at the first ED was barely positive at 0.06 She has not had a heart catheterization or after this event so the presence or absence of CAD is still unknown.

E-9-1-1 64

E-9-1-1 CAD OR STEMI 64

Dr. Smith's ECG Blog

MAY 10, 2023

CAD-RADS category 1. --No There are other actual uses and potential uses of CTCA, but the above is the most common. == MY Comment , by K EN G RAUER, MD ( 5/10 /2023 ): == Highly interesting case that illustrates a number of important concepts regarding Wellens' Syndrome and related disorders. A CT Coronary angiogram was ordered.

Coronary 52

Coronary STEMI CAD OR 52

Dr. Smith's ECG Blog

JUNE 18, 2013

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Am Heart J December 2014; 168:884-90. == MY Comment , by K EN G RAUER, MD ( 12/6 / 2023 ): == Even a decade ago — Dr. Smith was already convincingly diagnosing acute OMIs, as per his discussion above. Asymmetric.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. The Repeat ECG: As per Dr. McLaren — the patient was unfortunately discharged from the ED — but returned 6 hours later with a recurrence of chest pain.

STEMI 52

STEMI Coronary CAD OR 52