ACEP Now

APRIL 4, 2024

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). The patient initially presented to an outside ED and was subsequently transferred to our facility for continuity of care.

Coronary 40

Coronary STEMI CAD Emergency Department 40

Dr. Smith's ECG Blog

JUNE 18, 2013

This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. Ann Emerg Med 1998;31(1):3-11. See image below: Slow upstroke, fast downstroke.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

JULY 3, 2018

Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED.

ACS 52

ACS STEMI Coronary CAD 52

EMS 12-Lead

AUGUST 14, 2022

Otherwise, no admission of CAD, HLD, or family history of sudden cardiac death. The ST changes went overlooked by both the ED physician and the on-call cardiologist, and the patient was subsequently admitted to telemetry. A 12 Lead ECG was recorded: This is pathognomonic for classic deWinter T waves, indicative of LAD occlusion.

MICU 130

MICU STEMI CAD Coronary 130

Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. Scattered other nonobstructive CAD.

STEMI 127

STEMI CAD ED ALS 127

Dr. Smith's ECG Blog

AUGUST 9, 2019

Smith and Meyers answer: First , LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded. Chris Mondie of the Newark Beth Israel Emergency Medicine Residency sent case 1 below of a 100% LM occlusion. Beware crescendo angina in patient with known CAD ST Elevation in aVR Case 7.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

MARCH 24, 2023

Written by Jesse McLaren, with comments from Smith An 85 year old with a history of CAD presented with 3 hours of chest pain that feels like heartburn but that radiates to the left arm. The Repeat ECG: As per Dr. McLaren — the patient was unfortunately discharged from the ED — but returned 6 hours later with a recurrence of chest pain.

STEMI 52

STEMI Coronary CAD OR 52

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. He was worked up non-emergently in the ED with pain recurring and resolving multiple times during his stay. EKG 1, 1646: What do you think?

Coronary 73

Coronary ED CAD Paramedic 73

Dr. Smith's ECG Blog

DECEMBER 31, 2024

She presented to the Emergency Department at around 3.5 The procedure was described as very complex due to severe multivessel CAD, but ultimately PCI was successfully performed to the ostial LCX. Patients with complete left main occlusion usually die before arrival in the ED. Vital signs were within normal limits.

Coronary 125

Coronary ACS STEMI CAD 125

Dr. Smith's ECG Blog

MAY 17, 2025

Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. Conceptually there is a major misunderstanding inherent in the approach by many in the ED. Many authors state that if troponins are undetectable and ECG is normal, no further testing should be done.

Coronary 76

Coronary CAD ED OR 76