Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. One need not have obstructive coronary disease to have occlusive thrombus!

Emergency Department 52

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

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 82

ACS Coronary ALS CAD 82

Dr. Smith's ECG Blog

APRIL 14, 2023

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. Pre-intervention.

CAD 52

CAD ACS STEMI Coronary 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension. Answer below in the still shot.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

OCTOBER 26, 2020

EMS found the patient in VFib and performed ACLS for 26 minutes then obtained ROSC. The patient was transferred immediately for angiogram which revealed no significant CAD, and no intervention was performed. Coronary spasm causing massive current of injury with shark fin ECG. I suspect LAD or LM.

Coronary 40

Coronary Defibrillator ACS CAD 40

Dr. Smith's ECG Blog

JUNE 20, 2020

A 75 yo with h/o CAD, CABG, and HFrEF presented after a syncopal episode. Discussion Thus, no further ECGs were recorded and there was no angiogram or stress test or CT coronary angiogram. There is a limit to the amount of voltage that prehospital ECGs in most EMS systems are able to display. What do you think?

STEMI 52

STEMI CAD OR Coronary 52

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. The patient was treated as possible NSTEMI and underwent coronary angiography about 4 hours after presentation. They shocked him twice before return of spontaneous circulation.

Coronary 118

Coronary CAD CPR Critical Care 118

EMS 12-Lead

APRIL 8, 2022

He reported to EMS a medical history of GERD only. Furthermore, there was no family history of early CAD, MI, or sudden cardiac death. V2 – in the final EMS ECG the ST segment was baseline. V3 – in the final EMS ECG the ST segment was still slightly depressed. However, in this context (i.e. 1] Driver, B.

STEMI 130

STEMI ALS Coronary CAD 130

EMS 12-Lead

AUGUST 14, 2022

EMS personnel found him seated on a bench, uncomfortable, but without gross distress. Otherwise, no admission of CAD, HLD, or family history of sudden cardiac death. A second 12 Lead ECG was recorded: This is a testament to the dynamic nature of coronary thrombosis and thrombolysis. But the lesion is still active!

MICU 130

MICU STEMI CAD Coronary 130

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

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was EMS recorded the following ECG: What do you see? This is a very common misread. It may be difficult to read STEMI in the setting of RBBB.

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow).

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She also had non-acute CAD of the left main (50%) and LCX (75%). The Portable Programmable Microprocessor-Driven Real-Time 12-Lead Electrocardiographic Monitor: A Preliminary Report of a New Device for the Noninvasive Detection of Successful Reperfusion or Silent Coronary Reocclusion. J of National Association of EMS Physicians 2014.

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2024

These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. He took two full strength aspirin prior to EMS arrival. No prior similar symptoms or known CAD.

OR 110

OR STEMI Coronary CAD 110