Dr. Smith's ECG Blog

NOVEMBER 15, 2023

She was brought in by ambulance and received aspirin and nitroglycerin en route. Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. IMPRESSION: 1. Stroke-volume:50 ml.

Coronary 109

Coronary E-9-1-1 STEMI ACS 109

Dr. Smith's ECG Blog

DECEMBER 19, 2023

[link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. The ambulance report says "BP continued to drop during transport and pt remained cold and clammy." But there are other KEY changes!

E-9-1-1 127

E-9-1-1 Coronary ACS BLS 127

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

Dr. Smith's ECG Blog

AUGUST 9, 2018

Ambulated to ambulance for eval. The coronaries were clean (this is not the gold standard, however, as some patients with ischemic ST elevation may have clean coronaries). ACTUAL CORONARY ANATOMY: Dominance: Right LM: A 5 mm vessel which bifurcates into the LAD and LCx coronary artery. How did I avoid it?

E-9-1-1 52

E-9-1-1 STEMI Coronary Ambulance 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused.

E-9-1-1 52

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

Dr. Smith's ECG Blog

JANUARY 5, 2025

Beats 1-2 and 7-10 are wider, uniform, and regular. I doubt retrograde conduction because the RP interval is variable between 8 and 9. On Sunday, the patient complained of dyspnea and angina while ambulating. Wrong vessel PCI is very common, it happens in about 1 in 4 NSTEMIs. Repeat ECG is shown.

E-9-1-1 77

E-9-1-1 Coronary OR Ambulance 77