Dr. Smith's ECG Blog

DECEMBER 5, 2023

He did have a family history notable for early CAD. hematological disorder like sickle cell or antiphospholipid syndome, family history of CAD or hypercholesterolemia, prior history of vasculopathies such as Kawasaki Disease, MIS-C, prior cardiac surgery, etc.) He denied drug or alcohol use. mg/L and a normal WBC of 8.8. .-

Coronary 101

Coronary CAD ACS ALS 101

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

EMS 12-Lead

AUGUST 14, 2022

Otherwise, no admission of CAD, HLD, or family history of sudden cardiac death. He described the pain as “nagging,” and equally not exacerbated by any kind of movement. A pertinent medical history remarkable for HTN was disclosed, which was well controlled on Rx Olmesartan.

STEMI 130

STEMI MICU CAD Coronary 130

ESO

JULY 25, 2023

There are five NERIS Fire Data Standards currently in development today – they are: core fire data specification, CAD interface standard and API guide, incident, investigative, and exposure data standards. What are the milestones? NFIRS will remain operational throughout the completion and launch of the new NERIS system.

Emergency Response 52

Emergency Response CAD 52

The Skeptics' Guide to EM

JULY 2, 2022

Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? AEM June 2022.

Coronary 100

Coronary Heart Attack ACS CAD 100

EMDocs

NOVEMBER 29, 2023

Prospective observational pre/post cohort study including patients successfully resuscitated from OHCA without a clear diagnosis who were stable for CT Excluded < 18 years, DNR, obvious cause of arrest, severe renal dysfunction, known cardiomyopathy or obstructive CAD Control (Pre): Standard approach for diagnosis post-arrest but eligible for (..)

ICU 80

ICU CAD ALS OR 80

Dr. Smith's ECG Blog

OCTOBER 1, 2023

A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. This is a re-post of an excellent case from 2021. See it again now, along with our new Queen of Hearts functionality. We've come a long way in 2 years! And the pace only quickens.

OR 117

OR STEMI Coronary CAD 117

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. A quick way to validate this conjecture is to simply acquire a secondary ECG, but I failed to do this in the moment.

Coronary 130

Coronary ACS CAD ED 130

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. Well, most commonly we’re going to see ACS. Pregnancy itself with its bump in plasma volume, reduced Hb and increased cardiac output is like one long exercise stress test.

Critical Care 40

Critical Care CAD Plasma ACS 40

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.

ACS 130

ACS Coronary STEMI CAD 130

High Performance EMS

JANUARY 26, 2021

Your existing historical CAD records contain the necessary information to build such dynamic views in real-time. The existence of identifiable causes explains the ability to properly forecast the vicinity of calls in addition to their timing.

Emergency Response 100

Emergency Response Emergency Medical Services CAD Ambulance 100

EM Literature of Note

OCTOBER 18, 2021

CTCA certainly has a role in the evaluation of patients with chest pain and possible CAD, but certainly not as a routine investigation in the ED. So, a small decrease in invasive testing counterbalanced by the large baseline investment in non-invasive testing – without any clear patient-oriented benefit on health outcomes.

Coronary 40

Coronary CAD ED OR 40

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 108

STEMI Coronary ALS CAD 108

EMS 12-Lead

APRIL 8, 2022

Furthermore, there was no family history of early CAD, MI, or sudden cardiac death. He reported to EMS a medical history of GERD only. The physical exam was unremarkable for diaphoresis or pallor, and he denied any episodes of vomiting.

STEMI 130

STEMI ALS Coronary CAD 130

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. myocarditis).

Defibrillator 52

Defibrillator CPR Coronary CAD 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

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. AKI associated with GLP-1 agonist therapy is prerenal in nature and associated with nausea, vomiting, diarrhea, and reduced oral intake.

Allergic Reaction 73

Allergic Reaction ALS CAD OR 73

Dr. Smith's ECG Blog

MARCH 20, 2023

Angiogram soon after (around 4 hrs after presentation) showed multi vessel CAD, with culprit lesion total occlusion of the first obtuse marginal branch (OM1), which was stented. A repeat ECG at this time is below: The repeat ECG shows more STE (but still not 1.0 No more troponins were obtained. Unfortunately the echo was not available.

STEMI 52

STEMI ACS CAD ED 52

My Paramedic Blog

JULY 8, 2014

I hop into the ambulance, and log onto the CAD (Computer Assisted Dispatch) device. The call pops up onto our CAD. I look at the notes on the CAD it read: Crowning. Partner: “I’d prefer driving if you don’t mind.” Me: “Sure, that’s all good with me.” I wonder what intoxicated person we are going to pick up tonight. Me: “99 Fox.”

CAD 52

CAD Paramedic Ambulance Firefighter 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

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.

STEMI 52

STEMI 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.

ACS 78

ACS Coronary ALS CAD 78

Dr. Smith's ECG Blog

JUNE 12, 2017

He had a family history of early CAD and occasional drug and tobacco use. It is not yet available, but this is your way to get on the list. link] Here is the history: A 30 yo man presented complaining of severe chest pain. The ECG was alarming to the ED physician who did indeed review it.

STEMI 52

STEMI CAD Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

We also asked one of our electrophysiologists who states that patients should not be started on flecainide without first ruling out CAD, to prevent situations like this. The lower heart rate was maintained, as were the ST segment changes above, over the next 10 minutes in the resuscitation room. He was taken to the cath lab.

STEMI 52

STEMI ACS CAD OR 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

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed? This is a very common misread. It may be difficult to read STEMI in the setting of RBBB. The trick is to find the end of the QRS.

STEMI 52

STEMI CPR CAD Coronary 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion.

Coronary 52

Coronary STEMI Heart Attack OR 52

Dr. Smith's ECG Blog

JULY 11, 2019

He also had non-acute CAD of the RCA (50%) and LCX (50%). Cardiology was called and the patient was taken for urgent catheterization with the time from ED arrival to cath about 1 hour and 45 minutes. 100% proximal LAD thrombotic occlusion with TIMI 0 flow was found and stented with excellent angiographic result and TIMI 3 flow.

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

A woman in her 60s with no prior history of CAD presented with 3 hours of sharp, centrally located chest pain with radiation to the anterior neck, with associated nausea. Smith's ECG Blog, with nearly 100,000 views: Five Primary Patterns of Ischemic ST depression, without ST elevation. Some are STEMI-equivalents. She had known HTN and DM.

E-9-1-1 52

E-9-1-1 STEMI Coronary CAD 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

They found non-obstructive CAD, with only a 20% stenosis of OM2 and 10% RCA. A repeat ECG was performed and cardiology was re-consulted: Roughly unchanged. With the troponin elevated and ongoing pain, cardiology now decided to take him to the lab. No acute culprit. He was admitted to cardiology.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

JANUARY 20, 2024

Scattered other nonobstructive CAD. Angiogram around 9am: Culprit lesion mid LAD 100% stenosis TIMI 0 TIMI 3 after PCI Severe apical dyskinesis, severe anteroapical akinesis.

STEMI 104

STEMI CAD ALS ED 104

Dr. Smith's ECG Blog

OCTOBER 26, 2020

The patient was transferred immediately for angiogram which revealed no significant CAD, and no intervention was performed. I do not see clear evidence of OMI or reperfusion at this time. The patient received therapeutic hypothermia at 33 degrees C for 24 hours.

Coronary 52

Coronary Defibrillator ACS CAD 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

In this study of dialysis patients with severe CAD, 77% had an abnormal resting EKG and the most common abnormality was LVH. Another reason may be that the EKG is more difficult to interpret in patients with dialysis due to baseline abnormalities, including LVH. Herzog et al.

CAD 52

CAD OR ED ALS 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 65

E-9-1-1 CAD OR STEMI 65

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

ECG & Echo Learning

JANUARY 18, 2023

IIa C During hospital stay (after primary PCI) Either stress echo, CMR, SPECT, or PET may be used to assess myocardial ischaemia and viability, including in multivessel CAD. I C During hospital stay (after primary PCI) When echocardiography is suboptimal/inconclusive, an alternative imaging method (CMR preferably) should be considered.

STEMI 40

STEMI Coronary OR Defibrillator 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.

Coronary 52

Coronary ACS STEMI OR 52