ACS CAD Definition 
EMS 12-Lead
APRIL 9, 2024
Many of the changes seen are reminiscent of LVH with “strain,” and downstream Echo may very well corroborate such a suspicion, but since the ECG isn’t the best tool for definitively establishing the presence of LVH, we must favor a subendocardial ischemia pattern, instead. This was deemed “non-specific” by the ED physicians. Type I ischemia.
EMS 12-Lead
JULY 24, 2023
Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates. Smith : This is ACS even if the troponin returns normal, and the first troponin especially might return normal. It is accelerated angina, which is by definition not stable.
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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. ACS then becomes less likely. Before the lab values returned this patient had a n emergent coronary CT angiogram done that ruled out CAD. How would you assess this ECG? How confident are you in your assessment?
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. In our opinion it should not be given in ACS unless you are committed to the cath lab.
Dr. Smith's ECG Blog
OCTOBER 24, 2019
However, a smooth tapering of the mid-RCA was seen, highlighted in red below: How do we explain the MI if no sign of CAD was found? This MI wasn’t caused by a ruptured plaque of CAD - it was a coronary artery dissection of the RCA. SCAD isn’t rare, especially in women Historically SCAD had been identified in 22% of ACS cases in women.
Dr. Smith's ECG Blog
JULY 3, 2018
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. Lead aVL, for example, has a definite J-wave. Stat echo would also be helpful.
Dr. Smith's ECG Blog
NOVEMBER 30, 2022
The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. Just because you don't see hemodynamically significant CAD on angiogram does not mean it is not OMI. I could have told you this (and did tell you this) without an MRI.
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