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. This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System.

CAD 96

CAD STEMI ACS ALS 96

Core EM

DECEMBER 1, 2023

Metoprolol Considerations: Dosing (5 mg every 10-15 minutes, max 15 mg), benefits in CAD and HF, limitations in asthma/COPD patients. Treatment Approaches for AF Types General Rapid AF: First Line Agents: Metoprolol vs. Diltiazem. Diltiazem Advantages: Faster action, suitability in asthma/COPD, typical dosing (0.25 mg/kg if needed).

CAD 130

CAD OR 130

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?

Coronary 99

Coronary CAD ACS OR 99

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 119

Coronary CAD ACS ALS 119

Dr. Smith's ECG Blog

FEBRUARY 12, 2024

This is for the version housed on Telegram: [link] You can get the full PM Cardio app here if you live in the UK or EU (or say you do upon registration): [link] Case Continued The cath lab was activated and the patient received 180 mg of ticagrelor, and then was transported to the cath lab.

CAD 92

CAD ED OR Coronary 92

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

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). Implementation and Benefits NERIS will require a significant update to the current records management system software, or alternatively, the use of a new free app for collecting incident data.

Firefighter 59

Firefighter Emergency Response CAD OR 59

Dr. Smith's ECG Blog

JUNE 23, 2024

Stated differently, the differential diagnosis for the presenting syndrome was either ventricular fibrillation due to acute coronary syndrome, or idiopathic ventricular fibrillation and bystander stable CAD.

Coronary 115

Coronary CAD CPR Critical Care 115

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 128

OR STEMI Coronary CAD 128

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

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

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

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

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

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

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 61

STEMI Coronary CAD ED 61

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

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 121

STEMI Coronary ALS CAD 121

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

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 74

Allergic Reaction ALS CAD OR 74

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

OntarioMedic

FEBRUARY 8, 2018

Table 1: American College of Cardiology–American Heart Association Classification of Chronic Heart Failure Stage Description A: High risk for developing heart failure Hypertension, diabetes mellitus, CAD, family history of cardiomyopathy B: Asymptomatic heart failure Previous MI, LV dysfunction, valvular heart disease C: Symptomatic heart failure Structural (..)

Coronary 52

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.

ACS 84

ACS Coronary ALS CAD 84

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