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 In the largest study looking at this topic by Mizusawa et al., He denied chest pain or shortness of breath.

E-9-1-1 91

E-9-1-1 CAD STEMI OR 91

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.

ACS 84

ACS Coronary ALS CAD 84

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

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Fesmire et al. Wang T, Zhang M, Fu Y, et al. Sorajja P, Gersh BJ, Cox DA, et al. Pride YB, Tung P, Mohanavelu S, et al. Marti D et al. See image below: Slow upstroke, fast downstroke. Asymmetric.

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. The ECG was alarming to the ED physician who did indeed review it. 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.

STEMI 52

STEMI CAD Coronary ALS 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Smith and Meyers answer: First , LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded. 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. Widimsky P et al. Knotts et al. References 7.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think? 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. What will you do for this asymptomatic patient??? They opened it.

STEMI 52

STEMI ALS ACS ICU 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. The patient arrived in the ED and had this ECG recorded: Interpretation? See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. This is a very common misread.

STEMI 40

STEMI CPR CAD Coronary 40

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

SEPTEMBER 29, 2018

His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. In this study of dialysis patients with severe CAD, 77% had an abnormal resting EKG and the most common abnormality was LVH. Herzog et al.

CAD 52

CAD OR ED ALS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. 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. Taglieri N, Marzocchi A, Saia F, et al. Kosuge M, Ebina T, Hibi K, et al. Khot, MD; et al.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

JULY 11, 2019

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. He also had non-acute CAD of the RCA (50%) and LCX (50%). I focus my att ention on the interpretation of the initial ED tracing ( = E CG # 1 in Figure-1 ).

STEMI 52

STEMI ACS CAD ED 52

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.

STEMI 40

STEMI Coronary ALS CAD 40

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 CAD 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. Here is his ED ECG: There is obvious infero-posterior STEMI. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. Most recent echo showed EF of 60%.

STEMI 52

STEMI Plasma Defibrillator OR 52

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 122

STEMI CAD ED ALS 122

Dr. Smith's ECG Blog

DECEMBER 5, 2023

He did have a family history notable for early CAD. An ECG was perfomed on arrival to our ED: NSR with ST elevation II,III, aVF with reciprocal depression in aVL Would you refer this pediatric patient for emergent PCI? He denied drug or alcohol use. The workup at the transferring hospital yielded elevated troponin I at 18.1

Coronary 122

Coronary CAD ACS ALS 122

EMDocs

JANUARY 8, 2025

He has a history of CHF, dilated cardiomyopathy, HTN, HLD and CAD. Remember, from the ED point of view, if you are confronted with a wide complex regular tachydysrhythmia, assume VTach until proven otherwise! Isenhour JL, Craig S, Gibbs M, et al. This EKG comes from a 75-year-old male presenting with palpitations. Vereckei A.

CAD 94

CAD EMS Emergency Department ED 94