Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. CORONARY ARTERIES: Exam was not directly tailored for coronary artery evaluation, noting recent diagnostic coronary angiogram.

Coronary 108

Coronary E-9-1-1 STEMI ACS 108

Emergency Medicine Cases

SEPTEMBER 12, 2023

Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing (..)

Coronary 303

Coronary OR EMS 303

EMergucate

JUNE 7, 2023

Myocardial infarction with non-obstructive coronary arteries: what is the prognosis? Giampaolo Niccoli1,2 and Paolo G. Camici3* 1Universita’ Cattolica del Sacro … Continue reading →

Coronary 100

Coronary 100

EMS 12-Lead

APRIL 9, 2024

There is increased LV cavity dimensions with an increase in transient ischemic dilation, suggesting Left Main, or 3-vessel coronary artery disease. 2. Coronary angiography reveals significant and severe CAD involving all three epicardial vessels. Strongly positive stress ECG Lexiscan administration. He was taken to the Cath Lab.

Coronary 290

Coronary ACS CAD ED 290

The Skeptics' Guide to EM

JULY 2, 2022

Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? He has no history of coronary artery disease. Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. AEM June 2022.

Coronary 100

Coronary Heart Attack ACS CAD 100

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Acute coronary syndrome in a pediatric patient? Ultimately, cardiac cath was done — revealing patent coronary arteries. Written by Kirsten Morrissey, MD with edits by Bracey, Grauer, Meyers, and Smith An older teen was transferred from an outside hospital with elevated serum troponin and and ECG demonstrating ST elevations.

Coronary 120

Coronary CAD ACS ALS 120

St. Emlyn's

JULY 3, 2024

FOAMed The post JC: Systematic review of the Manchester Acute Coronary Scores. St.Emlyn's - Emergency Medicine #FOAMed Journal Club on the impact of the MACS score in emergency medicine (systematic review). Learn how this tool improves diagnosis and patient outcomes while optimising hospital resources."FOAMed

Coronary 74

Coronary 74

The Skeptics' Guide to EM

NOVEMBER 25, 2023

A 12-lead electrocardiogram (ECG) demonstrates ST elevations in leads II, III, and aVF with ST depressions in leads I and aVL and the team begins transport to the nearest percutaneous coronary intervention (PCI) capable hospital. Background: We have covered the issue of heart attacks several times on the SGEM. Reference: Stopyra et al.

Heart Attack 273

Heart Attack STEMI Emergency Medical Services Coronary 273

ACEP Now

DECEMBER 6, 2024

A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD), asthma, amphetamine and tetrahydrocannabinol (THC) use, and coronary vasospasm presented to triage with chest pain. During assessment, the patient reported that a left heart catheterization six months prior indicated spasms but no coronary artery disease.

Coronary 52

Coronary Life Support ALS Emergency Department 52

Emergency Medicine Cases

DECEMBER 20, 2023

ST/T changes: consider the differential including demand ischemia, associated electrolyte abnormalities, Brugada pattern from sodium channel blockade, and acute coronary occlusion vs vasospasm from cocaine. The post ECG Cases 47 – ECG Interpretation in Toxicology appeared first on Emergency Medicine Cases.

Coronary 212

Coronary OR Overdose EMS 212

Core EM

JULY 23, 2024

Isolated posterior MI is less common (3-8% of OMI) and presents with isolated ST-depressions in the anterior precordial leads (V1-V4), representing reciprocal changes to posterior left ventricular wall myocardial infarction as a result of distal occlusion of either the left circumflex or right coronary artery.

STEMI 173

STEMI Coronary Emergency Department OR 173

Dr. Smith's ECG Blog

JUNE 5, 2024

Why Was Cardiac Cath Negative for Coronary Disease? As noted by Dr. Nossen — this patient qualified as MINOCA ( M yocardial I nfarction with N on- O bstructive C oronary A rteries ) — since troponin was positive on his 2nd admission, yet there was no evidence of obstructive coronary disease on cath.

Coronary 115

Coronary ACS ALS OR 115

Emergency Medicine Cases

JUNE 18, 2024

In this month's EM Quick Hits podcast: Megan Landes on the importance of diagnosing HIV in the ED, Jesse McLaren on the failed paradigm of STEMI criteria and ECG tips to identify acute coronary occlusion, Anand Swaminathan on evidence for non-invasive airway management in the poisoned patient, Brit Long and Hans Rosenberg on the identification, workup (..)

STEMI 171

STEMI EMS Coronary ED 171

EMOttawa

APRIL 9, 2024

Question and Methods: The authors completed preplanned subgroup analyses to determine if a 0-1 hour ultra-sensitive troponin […] The post Sensitivity Cardiac Troponin T Among Patients With Known Coronary Artery Disease appeared first on EMOttawa Blog.

Coronary 61

Coronary ALS 61

St. Emlyn's

JULY 3, 2024

FOAMed The post Systematic review of the Manchester Acute Coronary Scores. St.Emlyn's - Emergency Medicine #FOAMed Journal Club on the impact of the MACS score in emergency medicine (systematic review). Learn how this tool improves diagnosis and patient outcomes while optimising hospital resources."FOAMed

Coronary 52

Coronary 52

REBEL EM

SEPTEMBER 21, 2023

What Your Gut Says: The patient has a tachydysrhythmia which may be the presentation of acute coronary syndrome (ACS) even though the patient has no ischemic symptoms. Essentially, we are using the troponin assay to find patients with ACO who may be benefited by coronary interventions or risk factor modification.

Coronary 143

Coronary ACS ED OR 143

EMergucate

JANUARY 10, 2023

The following ECG was obtained from a 61 year old man with coronary artery disease and previous coronary stents. Please … Continue reading →

Coronary 130

Coronary EMS 130

Dr. Smith's ECG Blog

JANUARY 25, 2024

A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain. As per Dr. Smith — today's patient is a 40-something year old patient with severe diabetes, renal failure and known coronary disease — who presents with “acute crushing CP”. Here is his ED ECG: What do you think?

Coronary 80

Coronary ED OR 80

Core EM

NOVEMBER 15, 2023

The Case A 62-year-old male with a history of Hypertension, Hyperlipidemia, Coronary Artery Disease with stents, Pulmonary Embolism on Eliquis, presents with sudden onset, severe, mid-sternal chest pain that started 15 minutes prior to arrival. Discussion Case Discussion: The patient’s history was concerning for an acute coronary syndrome.

Coronary 130

Coronary STEMI ED 130

EMS 12-Lead

JULY 24, 2023

Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates. It’s judicious, then, to arrange for coronary angiogram. Supply-demand mismatch (non-occlusive coronary disease, or exacerbation of preexisting flow insufficiency) a.

Coronary 130

Coronary ACS CAD ED 130

Core EM

JANUARY 25, 2024

Risk factors that increase the likelihood of VT include history of previous myocardial infarction, known coronary artery disease, and structural heart disease. Increased age is also an independent risk factor for increased likelihood of VT in wide complex tachycardia. When in doubt, treat as ventricular tachycardia.

Coronary 246

Coronary Emergency Department ED OR 246

The Skeptics' Guide to EM

OCTOBER 20, 2018

The acute coronary syndrome work-up is negative but she is Well’s high and needs a CTPA to rule-out a pulmonary embolism. Lauren is currently funded by an NHLBI K12 grant (1K12HL138049-01) studying the implementation of evidence-based diagnosis of pulmonary embolism in the emergency department. Case: A 64-year-old woman with type-2 diabetes.

Coronary 174

Coronary Emergency Department ALS OR 174

Core EM

FEBRUARY 23, 2024

Isolated posterior MI is less common (3-8% of OMI) and presents with isolated ST-depressions in the anterior precordial leads (V1-V4), representing reciprocal changes to posterior left ventricular wall myocardial infarction as a result of distal occlusion of either the left circumflex or right coronary artery.

STEMI 130

STEMI Coronary Emergency Department OR 130

REBEL EM

JUNE 1, 2023

Indication for emergency invasive coronary angiography or had coronary angiography within 1 hour of arrival. Known obstructive coronary artery disease or known coronary stent. Design: Prospective, observational, before and after implementation of a protocol study. Known cardiac defibrillator. Pre-existing DNR order.

Coronary 145

Coronary Defibrillator CPR ALS 145

EMS 12-Lead

SEPTEMBER 6, 2022

Coronary thrombosis is a dynamic process of platelet aggregation and subsequent coagulation. During spontaneous reperfusion -- whether via thrombolysis, or recruitment of collateral circulation -- there exists characteristic ST/T changes on the ECG. Case Review: [link]

Coronary 130

Coronary OR 130

EMergucate

NOVEMBER 28, 2022

She thinks she may have had stenting to her coronaries but … A 52 year old woman is triaged as a category 2 after complaining of chest tightness on the background of having previous cardiac history.

Coronary 130

Coronary 130

EMS 12-Lead

MAY 20, 2022

Additional architectural changes include systolic anterior motion of the mitral valve, endothelial dysfunction at the level of the coronary arterial bed, and ventricular diastolic dysfunction. This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. It is spread to V2 and V3. References Naidu, S.

Coronary 130

Coronary STEMI Firefighter ED 130

Dr. Smith's ECG Blog

JULY 25, 2024

But cardiac arrest is a period of near zero flow in the coronary arteries and causes SEVERE ischemia. Smith's ECG Blog ( See My Comment in the March 1, 2023 post) — DSI does not indicate acute coronary occlusion! It also does not uniformly indicate severe coronary disease. And what do you want to do?

Defibrillator 119

Defibrillator Coronary Epinephrine ACS 119

Emergency Medicine Cases

NOVEMBER 19, 2019

Can you identify which ones had acute coronary occlusion? In this ECG Cases blog we look at 8 patients with potentially ischemic symptoms, to highlight pearls and pitfalls of inferior MI. The post ECG Cases 3: Can you find the subtle inferior MI? appeared first on Emergency Medicine Cases.

Coronary 130

Coronary STEMI EMS 130

The Skeptics' Guide to EM

JANUARY 18, 2020

Date: January 16th, 2020 Reference: Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting? Date: January 16th, 2020 Reference: Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting? Reference: Wang et al.

ACS 130

ACS Coronary Emergency Department ALS 130

Emergency Medicine Cases

DECEMBER 16, 2019

Which had acute coronary occlusion? In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Introducing the concept of Occlusion MI - a paradigm shift in ECG diagnosis of MI. The post ECG Cases 4: Lateral STEMI or Occlusion MI?

STEMI 130

STEMI OR Coronary 130

Emergency Medicine Cases

MARCH 10, 2020

Which had acute coronary occlusion? 10 patients presented with the "STEMI-equivalent" ST elevation in aVR with diffuse ST depression. Jesse McLaren guides us through the differential diagnosis of ST elevation in aVR with diffuse ST depression in this ECG Cases blog. The post ECG cases 7: ST elevation in aVR, STEMI-equivalent?

STEMI 130

STEMI Coronary EMS 130

Dr. Smith's ECG Blog

APRIL 18, 2024

The ECG is just a test: a Bayesian approach to acute coronary occlusion If a patient with a recent femur fracture has sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis, the D-dimer doesn’t matter: the patient’s pre-test likelihood for PE is so high that they need a CT. A Bayesian approach to acute coronary occlusion.

STEMI 124

STEMI Coronary ALS CAD 124

Emergency Medicine Cases

AUGUST 16, 2022

Which patients with ECG evidence of coronary occlusion require a CT scan to rule out aortic dissection? What are the range of ECG findings in acute aortic dissection and how do they change management? Dr. Jesse McLaren guides us through 9 cases to answer these and other questions on ECG interpretation in aortic dissection.

Coronary 130

Coronary STEMI EMS 130

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent!

Coronary 132

Coronary ACS Emergency Department Epinephrine 132

Emergency Medicine Cases

SEPTEMBER 15, 2020

Which had an acute coronary occlusion? Signs of occlusion MI in patients with LVH include: new Q waves/loss of R waves, disproportionate and dynamic ST elevation (or ST depression from posterior MI), and hyperacute T waves. In this ECG Cases blog we look at 6 patients who presented with potentially ischemic symptoms and LVH on their ECG.

STEMI 130

STEMI Coronary OR EMS 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients. Emergency coronary angiography is reasonable for select (eg, electrically or hemodynamically unstable) adult patients who are comatose after OHCA of suspected cardiac origin but without ST elevation on ECG (Class IIa, LOE B-NR).

EMR 130

EMR Coronary Defibrillator Life Support 130