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. The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. 2009;95:1701–1706.

ACS 83

ACS Coronary ALS CAD 83

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Just because you don't see hemodynamically significant CAD on angiogram does not mean it is not OMI. It can only be seen by IVUS.

Emergency Department 52

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

Dr. Smith's ECG Blog

MARCH 19, 2023

Concerning history, known CAD" Recorded 2 hours after pain onset: What do you think? To realize — Assessment of ECG #1 is complicated by knowing: i ) That today’s patient has a history of documented CAD ; and , ii ) The lack o f a prior tracing for comparison at the time the initial ECG was interpreted. What Do We Learn from ECG #3 ?

STEMI 52

STEMI Coronary CAD OR 52

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. 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 92

E-9-1-1 CAD OR STEMI 92

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. Teaching points: 1.

ACS 52

ACS STEMI Coronary CAD 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

Second , the increased demand created by extreme tachycardia may exceed the ability of the coronary arteries to supply sufficient blood (due to preexisting three vessel or left main disease, with or without ACS). But this is not definite because the angiogram was not done at the same time as the ECG changes suggesting OMI.

STEMI 52

STEMI ACS CAD OR 52

Dr. Smith's ECG Blog

JUNE 20, 2020

A 75 yo with h/o CAD, CABG, and HFrEF presented after a syncopal episode. The QRS duration is 118 ms , so by definition it is not Left Bundle Branch Block (which must be 120 ms at a minimum and is usually longer) Thus, LVH on the ECG does not always correlate with anatomic LVH. What do you think? There is LVH.

STEMI 52

STEMI CAD OR Coronary 52

Dr. Smith's ECG Blog

JULY 11, 2019

He also had non-acute CAD of the RCA (50%) and LCX (50%). This is a h igher - p revalence H istory for acute coronary disease. B OTTOM L ine : While ECG #1 does not satisfy the definition of a STEMI — as per Dr. Meyers, it really looks like a cute L AD O MI. Cath images: Before intervention.

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

MARCH 6, 2019

Lead I has a definitively hyperacute T-wave without STE. She also had non-acute CAD of the left main (50%) and LCX (75%). Compared with sustained STEMI, transient STEMI was associated with less myocardial damage, less extensive coronary artery disease, higher TIMI flow grade, and better cardiac function. They opened it.

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. Use STEMI criteria to identify acute coronary occlusion: the ECG was STEMI negative 2. Below is the ECG. What do you think?

STEMI 52

STEMI Coronary CAD OR 52

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Written by Pendell Meyers A woman in her 70s with known prior coronary artery disease experienced acute chest pain and shortness of breath. Her history and ECG were interpreted as very concerning for acute coronary syndrome which might benefit from acute reperfusion therapy. Vital signs were within normal limits. hours since onset.

Coronary 119

Coronary ACS STEMI CAD 119

Dr. Smith's ECG Blog

NOVEMBER 19, 2024

No prior similar symptoms or known CAD. Here is the repeat 12 Lead ECG approximately 20 minutes later (still pain free) Now it shows definite reperfusion More inferior T-wave inversion Less STD in V2, V3. post OMI with significant multi-vessel coronary disease. He took two full strength aspirin prior to EMS arrival.

OR 110

OR STEMI Coronary CAD 110

Dr. Smith's ECG Blog

JANUARY 24, 2025

Written by Willy Frick A 52 year old man with hypertension, dyslipidemia, and seropositive rheumatoid arthritis (a risk factor for CAD) presented with acute substernal chest pressure with diaphoresis which woke him from sleep just after midnight. He said it felt like "someone ripped [his] heart out." But that is not what happened.

STEMI 125

STEMI CAD Coronary ED 125

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. He looked back in time in the patient's chart and saw these ECGs and immediately recognized that they manifested subtle OMI. He had an EKG recorded right away.

Coronary 68

Coronary ED CAD Paramedic 68