ACEP Now
OCTOBER 29, 2024
Does that normal troponin and ECG obviate the need for cardiology consultation for my patient with a concerning story for acute coronary syndrome? After some fentanyl, applying traction, and “opening the book,” he improved. New York: Penguin Books. The astute triage nurse—based on gestalt—moved to earlier physician evaluation.
EMS 12-Lead
APRIL 2, 2022
He reported a history of ischemic cardiomyopathy with coronary stent placement approximately 10 years prior, but could not recall the specific artery involved. So, when I first began teaching ECGs and writing my books (in the early 1980s) — I decided to synthesize my impressions of the literature into what I felt (e.g.
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Dr. Smith's ECG Blog
SEPTEMBER 27, 2023
The ECG below show a very clean and text book example of triangular QRST waveform also know "Shark Fin". Other coronaries were normal. Added on the right is the J-point marked with vertical red line. Is there OMI? How did the PM Cardio Queen of Hearts perform: OMI with high confidence.
Dr. Smith's ECG Blog
NOVEMBER 15, 2013
The above principles are all well illustrated with this figure from my book, The ECG in Acute MI (2002). It is important to recognize that coronary thrombosis is dynamic , with spontaneous opening and lysing of the thrombus in the infarct-related artery (we all have endogenous tPA and plasmin to lyse thrombi). Akkerhuis KM, et al.
Dr. Smith's ECG Blog
SEPTEMBER 7, 2024
I believe that I was the first to represent Wellens as a reperfusion syndrome, in my book , The ECG in Acute MI , pages 22-23 and 51, and in chapter 27 on Reperfusion and Reocclusion. From my experience, I am confident that if it were formally studied, it would be born out. Wehrens XH, Doevendans PA, Ophuis TJ, Wellens HJ. Am Heart J.
Dr. Smith's ECG Blog
APRIL 26, 2017
Note 2 other similar cases at the bottom that come from my book, The ECG in Acute MI. See similar cases below from my book, The ECG in Acute MI New 4-Variable Formula I have published a new formula for Early Repolarization vs. Subtle LAD Occlusion that solves the problem of false positives due to LVH by adding a 4th variable, QRS in V2.
Dr. Smith's ECG Blog
JULY 12, 2023
IF the clinical scenario for ECG #1 , was that this tracing was recorded in an ambulatory care setting from an otherwise stable patient with longstanding coronary disease but no new chest pain — then I would interpret this ECG as showing "nonspecific" ST-T wave abnormalities that are probably not acute.
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