Dr. Smith's ECG Blog

FEBRUARY 12, 2024

(THE PM CARDIO OMI AI APP) If you want this bot to help you make the early diagnosis of OMI and save your patient and his/her myocardium, you can sign up to get an early beta version of the bot here.

CAD 104

CAD ED OR Coronary 104

Dr. Smith's ECG Blog

MARCH 19, 2024

The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. HPI: Abrupt onset of substernal chest pain associated with nausea/vomiting 30 min PTA. This was stented with a 2.25

CAD 110

CAD STEMI ACS ALS 110

Dr. Smith's ECG Blog

APRIL 9, 2024

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. Before the lab values returned this patient had a n emergent coronary CT angiogram done that ruled out CAD. How would you assess this ECG? How confident are you in your assessment? What is your next step? How did the Queen do?

Coronary 107

Coronary CAD ACS OR 107

NVFC

JULY 16, 2024

Once the new system is in place, it will also be able to integrate information from the computer-aided dispatch system (CADS). By Tom Jenkins Reprinted from the 2024 issue of Firefighter Strong In the fire academy, I doubt any candidate firefighter is excited or intrigued about incident reporting.

Firefighter 105

Firefighter Emergency Response CAD OR 105

The Skeptics' Guide to EM

JULY 2, 2022

In prior decades nearly all patients presenting to EDs with chest pain were admitted to hospital. If we thought about ACS, we brought them in. This would be for objective cardiac testing including stress test, CT-angiography, and/or invasive angiography. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter?

Coronary 100

Coronary Heart Attack ACS CAD 100

EMS 12-Lead

JUNE 20, 2022

Moreover, he had no pertinent medical history to report in terms of CAD, HTN, HLD, or DM, for example. CASE 1 A 45 y/o Male called 911 for new onset central chest discomfort, non-radiating, 5/10 pain scale, and without any vomiting, diaphoresis, or pallor. A 12 Lead ECG was recorded. There is no dramatic change, or evolution.

ACS 130

ACS Coronary STEMI CAD 130

EMS 12-Lead

JULY 24, 2023

These concerns were readily conveyed to my supervising cardiologist with particular emphasis on high pretest probability for baseline advanced CAD (3-vessel disease, specifically) with a critically stenosed proximal LAD. This results in Type I MI. This results in Type II MI. What’s interesting is that the ECG can only detect ischemia.

Coronary 130

Coronary ACS CAD ED 130

Dr. Smith's ECG Blog

DECEMBER 16, 2018

She had a normal EF, and no significant CAD, and was taking flecainide to suppress the AF. Wide-complex tachycardia: VT or aberrant, or "other?" This case is contributed by Brooks Walsh , an EM physician and ECG expert from Connecticut. The case An older woman presented to the ED with dyspnea, diaphoresis, and chest pressure.

OR 52

OR ED CAD Overdose 52

ESO

SEPTEMBER 5, 2024

With API , participating CAD and RMS vendors will be able to automatically send data back and forth to NERIS. For any CAD and RMS vendors who are interested, you can share information and ask questions during the USFA development tea m’s regular NERIS office hours.

CAD 59

CAD Mobile Integrated Health PSAP Community Paramedicine 59

ESO

OCTOBER 1, 2024

We hope to have a basic NERIS-compliant beta early in 2025, with additional updates (CAD imports, ESO EHR integration, ESO Insights reporting, etc.) It will be a simplified version and may not yet be ideal for agencies with ESO suite integrations like CAD and EHR imports. The timeline may vary. What will ESO charge for NERIS?

CAD 59

CAD Public Safety First Responder OR 59

International Journal of Paramedicine

JULY 8, 2024

This included date, POE, patient demographics, chief complaint, computer-aided dispatch (CAD), provider impression (diagnosis), and time out of service. Results : Over the study period, 8,407 encounters occurred at one of the three El Paso-Juárez POE, averaging 1,680 per year or 140 calls per month.

Prehospital Care Provider 52

Prehospital Care Provider CAD Emergency Medical Services EMS 52

Dr. Smith's ECG Blog

APRIL 18, 2024

Similarly, if a patient with known CAD presents with refractory ischemic chest pain, the ECG barely matters: the pre-test likelihood of acute coronary occlusion is so high that they need an emergent angiogram. 1] European guidelines add "regardless of biomarkers".

STEMI 120

STEMI Coronary ALS CAD 120

High Performance EMS

JANUARY 26, 2021

Your existing historical CAD records contain the necessary information to build such dynamic views in real-time. The next step is to adequately distribute those available resources spatially to address the variation over the geographic area by time which requires an even deeper understanding of the call patterns.

Emergency Response 100

Emergency Response CAD Emergency Medical Services Ambulance 100

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Patient stated that he has had glucose over 400 even though he has not missed any doses of insulin. Aslanger's is a combination of inferior OMI with widespread ST depression and is due to BOTH occlusion of one artery (usually the circumflex, but sometimes the RCA) AND simultantous 3 vessel disease.

ED 117

ED Coronary CAD STEMI 117

EMDocs

FEBRUARY 7, 2024

Increased risk in those with preexisting CKD, other risk factors for renal disease (HTN or CAD), and those on ACEIs/ARBs. The effects of GLP-1 agonists are associated with the dose. Higher doses of GLP-1 agonists are associated with weight loss. Take for example semaglutide. Ozempic is utilized for DM2 in doses of 0.5, mg SQ every week.

Allergic Reaction 98

Allergic Reaction ALS CAD OR 98

Dr. Smith's ECG Blog

OCTOBER 24, 2019

However, a smooth tapering of the mid-RCA was seen, highlighted in red below: How do we explain the MI if no sign of CAD was found? This MI wasn’t caused by a ruptured plaque of CAD - it was a coronary artery dissection of the RCA. Angiography Angiography was performed after aspirin and heparin were started.

Coronary 52

Coronary CAD ACS STEMI 52

Dr. Smith's ECG Blog

DECEMBER 6, 2010

He had no previous history of CAD, and presented with very typical waxing and waning chest pain, much worse with exertion but also present at rest and on presentation, though his pain was minimal at the time of the ECG. I saw this 59 year old male 3 weeks ago. Blood pressure was 150/80. The ECG normalized overnight. Maximum troponin was 2.1

STEMI 52

STEMI CAD OR 52

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

JUNE 1, 2012

This was a middle aged female with a h/o CAD who presented to the ED by EMS sudden onset of central chest pressure 45 min prior to ED arrival with associated diaphoresis and SOB.  There is LVH and there are ST-T abnormalities (large inferior T-waves and ST elevation, with reciprocal findings in aVL).

STEMI 52

STEMI CAD ED EMS 52

Dr. Smith's ECG Blog

MAY 19, 2020

Diagnosis of MINOCA should be made according to the Fourth Universal Definition of MI, in the absence of obstructive coronary artery disease (CAD) (no lesion ≥50%). The authors recommend using optical coherence tomography or intravascular ultrasound imaging in patients with evidence of nonobstructive CAD by angiogram. The K was normal.

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

APRIL 24, 2015

He had a history of CAD with CABG. A middle-aged male had a V Fib arrest. He had not complained of any premonitory symptoms (which is very common). Here was his initial ED ECG: There is atrial fibrillation with a rapid ventricular response. There is profound ST depression especially in I, II, V2-V6. One should wait a short time (15 minutes?)

Defibrillator 52

Defibrillator ACS CAD STEMI 52

Emergency Medicine Ireland

DECEMBER 7, 2020

As the pregnant population continues to age and with RF and smoking and DM still common we can expect to see pregnant woman with CAD. Critical illness in pregnancy is remarkably rare given the somewhat bonkers system for reproduction that we seem to have evolved over the past million or years. Improved care of complex.

Critical Care 40

Critical Care CAD Plasma ACS 40

Dr. Smith's ECG Blog

JUNE 19, 2024

The ED provider ordered a coronary CT scan to assess the patient for CAD. Three months prior to this presentation, he received a pacemaker for severe bradycardia and syncope due to sinus node dysfunction. At around 1430, as the patient was being prepared to leave for the scan, he developed severe chest pain, dizziness, and became diaphoretic.

STEMI 60

STEMI Coronary CAD ED 60

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. There is no ST elevation.

STEMI 52

STEMI ACS Coronary CAD 52

Dr. Smith's ECG Blog

JUNE 12, 2017

He had a family history of early CAD and occasional drug and tobacco use. This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chest pain.

STEMI 52

STEMI CAD Coronary ALS 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.

STEMI 52

STEMI Coronary CAD OR 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. Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc. He was diagnosed as NSTEMI.

ACS 81

ACS Coronary ALS CAD 81

Dr. Smith's ECG Blog

JUNE 20, 2020

A 75 yo with h/o CAD, CABG, and HFrEF presented after a syncopal episode. There was no prodrome and no associated symptoms such as SOB or CP. The medics recorded an ECG: There is STE in V1-V3 and aVL, with reciprocal ST depression in II, III, aVF. The medics were worried about STEMI, as it meets STEMI criteria. What do you think?

STEMI 52

STEMI CAD OR Coronary 52

Dr. Smith's ECG Blog

MAY 10, 2023

CAD-RADS category 1. --No At this point, with the information above, the patient's overall clinical picture could be consistent with either reperfused OMI, or Non-OMI, since both may have absent pain and inverted T waves. A repeat troponin returned at 0.45 ng/mL, consistent with reperfused OMI, or Non-OMI. A CT Coronary angiogram was ordered.

Coronary 52

Coronary STEMI CAD OR 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

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. V1 has 0.5 mm of elevation. ng/mL [IQR: 0.46, 2.35]. Learning Points: 1.

Emergency Department 52

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

Dr. Smith's ECG Blog

JANUARY 28, 2018

He has a history of known CAD, diabetes, and dyslipidemia. This post was written by one of our fantastic Hennepin County Medical Center Emergency Medicine interns who is an ECG whiz, Daniel Lee. A man is his late 50’s presents to the ED with 1 hour of post exertional chest pressure associated with diaphoresis and nausea.

Coronary 52

Coronary STEMI CAD ED 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

They found non-obstructive CAD, with only a 20% stenosis of OM2 and 10% RCA. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms. No acute culprit. He was admitted to cardiology. Pericarditis?

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

ACEP Now

APRIL 4, 2024

This patient had known coronary artery disease (CAD), and previously required drug eluting stents to the obtuse marginal and diagonal arteries. A 59-year-old male with a past medical history of a repaired ventricular septal defect (VSD), dextrocardia, hypertension, hyperlipidemia, and current smoker presented to the emergency department (ED).

Coronary 40

Coronary STEMI CAD Emergency Department 40

Dr. Smith's ECG Blog

JULY 31, 2018

She had zero CAD risk factors. Post by Smith, with short article by Angie Lobo ( [link] ), a third year intermal medicine resident at Abbott Northwestern Hospital Case A 30-something woman with no past history, who is very fit and athletic, presented with 1.5 hours of substernal chest pressure. There is 1 mm of STE in lead V2.

Coronary 52

Coronary ACS STEMI OR 52

Dr. Smith's ECG Blog

JUNE 18, 2013

So I went to look at the chart and here is the history: This patient with no h/o CAD had a couple of episodes of chest pain during the day, then presented with one hour of substernal chest pain that had some reproducibility but also improved from 10/10 to 5/10 with nitroglycerine.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

JANUARY 31, 2020

Not immediately, at least, because this is NOT diagnostic of ACUTE (occlusion) myocardial infarction (Acute OMI). We need to do some more investigation. Although diagnostic of MI, it is highly suspicious for " Old inferior MI with persistent ST Elevation" or "inferior aneurysm morphology" because of the well-formed Q-waves and the flat T-waves.

ED 52

ED Coronary ACS CAD 52

ESO

JULY 3, 2024

On May 6, 2024, version 1 of NERIS core data schema was released, including: Fire Department (Entity) Specification CAD/Dispatch schema Incident schema Since the upgrade was announced, ESO’s Fire Incidents team has been preparing and planning to ensure your team will be ready for the transition to NERIS.

Mobile Integrated Health 52

Mobile Integrated Health MIH Critical Care Community Paramedicine 52