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. Hayakawa A, Tsukahara K, Miyagawa S, et al. Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc. Am J Emerg Med.

ACS 82

ACS Coronary ALS CAD 82

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. Conversely, Matetzky et al.

STEMI 52

STEMI ACS Coronary CAD 52

Dr. Smith's ECG Blog

JUNE 18, 2013

So I went to look at the chart and here is the history: This patient with no h/o CAD had a couple of episodes of chest pain during the day, then presented with one hour of substernal chest pain that had some reproducibility but also improved from 10/10 to 5/10 with nitroglycerine. Fesmire et al. Wang T, Zhang M, Fu Y, et al.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

JUNE 12, 2017

He had a family history of early CAD and occasional drug and tobacco use. Mawri S, Michaels A, Gibbs J, et al. It is not yet available, but this is your way to get on the list. link] Here is the history: A 30 yo man presented complaining of severe chest pain. The ECG was alarming to the ED physician who did indeed review it.

STEMI 52

STEMI CAD Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. J Electrocardiol [Internet] 2022;Available from: [link] Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%) V Fib Cardiac arrest Prolonged QTC NSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different) Moderate single-vessel CAD.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

As I met the paramedics and cath team in the lab, I was ready to see severe coronary disease (CAD), but the vessels were non-obstructive. Dobutamine may be preferred in patients without severe hypotension who have high vascular resistance. -- De Backer D et al. Taglieri N, Marzocchi A, Saia F, et al. Richard, C; et al.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

DECEMBER 29, 2015

Case history A middle-aged woman with a history of HTN, but no prior CAD, presented to the ED with chest pain. The criteria of Armstrong et al. One retrospective analysis by Armstrong et al. Armstrong EJ, Kulkarni AR, Bhave PD, et al. AT, Jaffa EJ, et al. Neuman Y, Cercek B, Aragon J, et al. Am J Emerg Med.

STEMI 40

STEMI Coronary ALS CAD 40

Dr. Smith's ECG Blog

JULY 11, 2019

He also had non-acute CAD of the RCA (50%) and LCX (50%). CLICK HERE — for a brief article by Rowlands et al that explains these concepts in more detail. Cardiology was called and the patient was taken for urgent catheterization with the time from ED arrival to cath about 1 hour and 45 minutes. Cath images: Before intervention.

STEMI 52

STEMI ACS CAD ED 52

EMS 12-Lead

APRIL 8, 2022

Furthermore, there was no family history of early CAD, MI, or sudden cardiac death. He reported to EMS a medical history of GERD only. The physical exam was unremarkable for diaphoresis or pallor, and he denied any episodes of vomiting. 1] Driver, B. Posterior wall reperfusion T-waves: Wellens’ syndrome of the posterior wall. 3] Niu, T.,

STEMI 130

STEMI ALS Coronary CAD 130

EMDocs

NOVEMBER 29, 2023

EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network. Author Takeaway: No difference in mortality at 60 days with methylprednisolone vs. placebo in severe CAP #3: Wu JY, Tsai YW, Hsu WH, et al. Reyes LF, Garcia E, Ibáñez-Prada ED, et al. N Engl J Med.

ICU 97

ICU CAD ALS OR 97

Dr. Smith's ECG Blog

JANUARY 20, 2024

Scattered other nonobstructive CAD. de Winter et al in N Engl J Med 359:2071-2073, 2008. Angiogram around 9am: Culprit lesion mid LAD 100% stenosis TIMI 0 TIMI 3 after PCI Severe apical dyskinesis, severe anteroapical akinesis. Figure-1: The de Winter T Wave Pattern , as first described by Robbert J.

STEMI 120

STEMI CAD ED ALS 120

Dr. Smith's ECG Blog

JULY 22, 2023

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. In the largest study looking at this topic by Mizusawa et al., Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al.

E-9-1-1 92

E-9-1-1 CAD OR STEMI 92

Dr. Smith's ECG Blog

JUNE 2, 2023

Late Gadolinium enhancement: Multifocal scarring of the septum (including RV septum), basal anterior wall and transmural mid inferior region scarring - a non-CAD hyperenhacement pattern. There is mild-moderate tricuspid valve regurgitation. Overall CMR findings are consistent with arrhythmogenic cardiomyopathy. RVEF 100 ml/m2.

ED 96

ED OR ALS CAD 96

Dr. Smith's ECG Blog

AUGUST 9, 2019

She had a proven 100% Left Main occlusion No ST shift in aVR This pattern of RBBB/LAFB was also the most common pattern in Fiol et al. See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. Widimsky P et al. Knotts et al. Rokos IC, French WJ, Mattu A, et al.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This study from Herzog et al (from our own Hennepin County Medical Center) included patients from a national registry and compared 3049 patients on dialysis admitted and eventually found to have acute MI compared with 534,395 patients not on dialysis admitted with an eventual diagnosis of acute MI. Herzog et al.

CAD 52

CAD OR ED ALS 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD. In the largest study looking at this topic by Mizusawa et al., 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 52

E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed?

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

MARCH 6, 2019

She also had non-acute CAD of the left main (50%) and LCX (75%). Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al. Krucoff et al.) ) to disastrous consequences that may deteriorate before the patient can be rushed to the cath lab. They opened it. Initial troponin T was 0.46

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

APRIL 8, 2016

He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. A late middle-aged man presented with one hour of chest pain. Most recent echo showed EF of 60%.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. There is a literature on this subject ( GGF van der Schoot et al: Neth Heart J 28(6):301-308, 2020 — and — Egred et al — Postgrad Med 81(962): 741-745, 2005 — to name just 2 reports ). No similar symptoms in the past.

Coronary 52

Coronary STEMI Heart Attack OR 52

ECG & Echo Learning

JANUARY 18, 2023

IIa C During hospital stay (after primary PCI) Either stress echo, CMR, SPECT, or PET may be used to assess myocardial ischaemia and viability, including in multivessel CAD. I C During hospital stay (after primary PCI) When echocardiography is suboptimal/inconclusive, an alternative imaging method (CMR preferably) should be considered.

STEMI 40

STEMI Coronary OR Defibrillator 40

EMDocs

JANUARY 8, 2025

He has a history of CHF, dilated cardiomyopathy, HTN, HLD and CAD. Isenhour JL, Craig S, Gibbs M, et al. For this box, please keep ventricular tachycardia (VTach) and supraventricular tachycardia with aberrancy (SVT with aberrancy) in your differential. This EKG comes from a 75-year-old male presenting with palpitations. Vereckei A.

CAD 98

CAD EMS Emergency Department ED 98

Dr. Smith's ECG Blog

DECEMBER 5, 2023

He did have a family history notable for early CAD. hematological disorder like sickle cell or antiphospholipid syndome, family history of CAD or hypercholesterolemia, prior history of vasculopathies such as Kawasaki Disease, MIS-C, prior cardiac surgery, etc.) He denied drug or alcohol use. mg/L and a normal WBC of 8.8. .-

Coronary 120

Coronary CAD ACS ALS 120