Dr. Smith's ECG Blog

MAY 20, 2024

A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.

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EKG/ECG Hospitals Wellness Emergency Department 110

Dr. Smith's ECG Blog

MAY 5, 2024

An undergraduate (not yet in medical school) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly arrived at work and happened to glance down and see this previously recorded ECG on a table in the ED. It was recorded at 0530: What do you think?

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EKG/ECG Wellness 99

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. Vitals were within normal limits except some hypertension. Which is true.

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EKG/ECG Documentation/Coding Emergency Department Hospitals 100

ECG Guru

SEPTEMBER 27, 2023

Intubated and given nitric oxide for pulmonary hypertension. This ECG was obtained at follow up appointment. Because newborns’ hearts are more to the right side, we often do right-sided chest leads in addition to the standard 12-lead ECG. Weaned in NICU over 10 days. Echocardiogram during that time showed stiff pulmonic valve.

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EKG/ECG Pediatrics Wellness 98

EMergucate

MARCH 19, 2024

The following ECG is from a 65 year old lady who has presented with two hours of central chest pain. She has a history of hypertension and is a current smoker. What are the key features on her ECG?…

EKG/ECG 52

EKG/ECG 52

Emergency Medicine Journal

MAY 28, 2024

Patients commonly present to the ED with cardiac sounding chest pain 1 and a non-diagnostic ECG, yet an important proportion will be suffering from a myocardial infarction (MI) eligible for percutaneous coronary intervention.

Emergency Department 52

Emergency Department Research EKG/ECG Hospitals 52

Emergency Medicine Cases

JUNE 6, 2023

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. For RV strain, acute vs chronic, we should look for signs of acute RV strain and chronic pulmonary hypertension.

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EKG/ECG EMS 94

Dr. Smith's ECG Blog

APRIL 22, 2024

A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. In the later, 2nd, ECG, the leads are correctly placed and the ST Elevation appears to be greater.

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EKG/ECG Outcomes Ultrasounds Hospitals 108

ECG Guru

MAY 27, 2023

This ECG is from an 80-year-old lady who has collapsed or had sycopal episodes several times. The ECG comes from a Holter monitor. She has arterial hypertension and coronary artery disease. The ECG shows a second-degree, Mobitz Type II AV block. In both types of AVB, the PP intervals are usually the same.

EKG/ECG 72

EKG/ECG 72

Ken Grauer, MD

FEBRUARY 13, 2023

The ECG in Figure-1 was obtained from an older woman — who presented with chest pain and palpitations over the previous hour. She had a history of hypertension, and was on medication for this — but she was otherwise healthy. Figure-1: ECG obtained from an older woman with palpitations. Is this Ventricular Bigeminy?

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EKG/ECG Poisoning 195

ECG Guru

MARCH 6, 2024

So, we can assume the patient was probably being treated for angina, heart failure, and hypertension. The ECG : The first impression is that is a regular WIDE COMPLEX TACHYCARDIA. Ntg is presumably sublingual nitroglycerine used for angina. Procardia (nifedipine) is a calcium-channel blocker.

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EKG/ECG 98

Dr. Smith's ECG Blog

MARCH 9, 2024

Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis. No further ECGs were obtained.

EKG/ECG 96

EKG/ECG 96

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. See Ken Grauer's additional comments about this ECG at the end of the post!

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EKG/ECG Emergency Department Ultrasounds Documentation/Coding 93

Dr. Smith's ECG Blog

APRIL 14, 2024

A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. Here is his first ECG (1/10 pain): Smith: sinus rhythm with RBBB and normal ST-T. An ECG from 4 years prior was the same. He presented on this day because it did not go away.

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EKG/ECG Ultrasounds EMS Wellness 93

Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Here is the prehospital ECG: First ED ECG What do you think? SVT with aberrancy?

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EKG/ECG EMS Emergency Department Ultrasounds 107

ECG Guru

JULY 30, 2023

The Patient: This ECG is from a 63-year-old man who complained of epigastric pain for three hours. The patient is a heavy smoker, diabetic and hypertensive with a long history of non-compliance to his medications. The ECG: The rhythm is normal sinus, a bit fast at 90 bpm. This is an ECG sign of GLOBAL ISCHEMIA.

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EKG/ECG Burns 52

Dr. Smith's ECG Blog

MARCH 26, 2024

Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. Moreover, there is tachycardia.

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EKG/ECG Shock Ultrasounds Wellness 66

Mind The Bleep

NOVEMBER 12, 2023

Strictly speaking, the definition of cardiomyopathy excludes myocardial dysfunction due to coronary artery disease, systemic hypertension and valvular or congenital heart disease. 12 lead ECG: variable findings but LVH, pathological Q waves, ST and T wave abnormalities are common. HCM is the most common cause of SCD in young people.

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EKG/ECG Research Outcomes 96

Dr. Smith's ECG Blog

AUGUST 14, 2023

Here is his triage ECG: What do you think? Chronic RVH is due to chronic pulmonary hypertension, and these patients are extremely difficult to manage when they are acutely ill. A prior ECG was available for comparison: There is sinus rhythm here; the QRS is the same We can see that the QRS is essentially the same as prior.

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EKG/ECG Blood Transfusions Wellness 52

ECG Guru

JULY 26, 2023

This is the ECG of an 81-year-old man with hypertension. Currently, he has no complaints: no palpitations, no shortness of breath, no syncope, no chest pain. The rhythm is irregular, but all P-waves have the same shape. There are no consequences for the patient resulting from this diagnosis.

EKG/ECG 52

EKG/ECG 52

ECG Guru

JULY 26, 2023

This is the ECG of an 81-year-old man with hypertension. Currently, he has no complaints: no palpitations, no shortness of breath, no syncope, no chest pain. The rhythm is irregular, but all P-waves have the same shape. There are no consequences for the patient resulting from this diagnosis.

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EKG/ECG 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Initial high sensitivity troponin I: 3,830 ng/L (URL 20 ng/L for men) 1445: Similar to initial ECG. He was intubated for altered mental status. ST depression.

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EKG/ECG Wellness Fractures Hospitals 92

Dr. Smith's ECG Blog

JANUARY 31, 2024

He has a history of untreated hypertension. The patient is pain free at the time of this ECG: What do you think? But the ECG tells us that that there is also old or subacute MI. I offer a few additional thoughts on today's initial ECG — which I've reproduced in Figure-1. Figure-1: The initial ECG in today's case.

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Wellness EKG/ECG 86

Dr. Smith's ECG Blog

MARCH 13, 2024

Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. He went to urgent care and had an ECG (not available) which was interpreted as normal, and was sent home. His ECG is shown: What do you think? Activate the cath lab!

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EKG/ECG Urgent Care Sepsis Wellness 77

EMDocs

DECEMBER 11, 2023

The most common diagnostic test to identify patients who might require percutaneous intervention is the electrocardiogram (ECG). Emergency physicians have recognized for some time that there are many occlusions of the coronary arteries that do not present with classic STEMI criteria on the ECG.

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EKG/ECG Emergency Department Academics Operations 109

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. This ECG was recorded in triage. Case Continued The ECG findings were not recognized. Therefore, no matter the initial ECG, record serial ECGs.

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EKG/ECG Resuscitation CPR Emergency Department 116

Ziqitza HealthCare Ltd

APRIL 29, 2024

Some common types of cardiovascular disease are coronary heart disease, stroke, hypertension, arrhythmia, aortic disease, valve disease, heart failure, and peripheral artery disease. Hypertension can cause types of cardiovascular diseas e , causing effects like heart attack and stroke. Cardiovascular diseases are common.

Stroke 52

Stroke Ambulance Services Burns EKG/ECG 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

This is by Magnus Nossen, from Norway The patient is a 70 something male with a hx of hypertension and tobacco use disorder. The ECG below was recorded and electronically transferred to our PCI center for evaluation. ECG #1 I think many providers might be reassured viewing this ECG. The ECG is live fed to our institution.

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EKG/ECG EMS Wellness 59

Dr. Smith's ECG Blog

JANUARY 27, 2024

Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal? What do you think?

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EKG/ECG Emergency Department Outcomes Wellness 88

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.

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EKG/ECG Documentation/Coding Wellness Emergency Department 101

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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EKG/ECG EMS Wellness Operations 104

Dr. Smith's ECG Blog

AUGUST 30, 2020

This ECG was texted to me with the message "A 31 year old with Diabetes and HTN complains of bilateral arm tingling and headache." ECGs are often like faces to me. I sent the ECG to Pendell and he answered: "It seems like very high chance of false positive for LVH. Never chest pain but had to treat as hypertensive emergency.

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EKG/ECG Wellness 52

Mind The Bleep

FEBRUARY 1, 2024

Risk Factors Risk factors include: Hypertension Age Diabetes High cholesterol Smoking Hyper-coagulability Oral contraceptives (COCPs) Clinical Features Sudden, painless loss of vision Bruit/arrythmias may be present Ensure to assess cardiovascular risk factors On Fundoscopy Pale retina with cherry red spot.

Stroke 52

Stroke EKG/ECG 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

In reviewing the case, I saw the ECG and recognized it as the same one. Here is the ECG from that visit: Nothing Diagnostic, just a lot of nonspecific ST-T abnormalities. This suggests that there is pulmonary hypertension and thus possibly RVH. We recorded another ECG 3 hours after the first: The findings in V2 and V3 persist.

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EKG/ECG Sepsis Ultrasounds 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

The following ECG was recorded. The presenting ECG shows SR with narrow QRS complexes. First troponin I returned 3174 ng/l, at which point a repeat ECG was ordered. Not much difference from 1st ECG. Any cause of pulmonary hypertension. At this point an old ECG on file was found for comparison.

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EKG/ECG COPD Wellness Shock 84

Dr. Smith's ECG Blog

JANUARY 1, 2024

His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. An initial electrocardiogram (ECG) is provided below. What do you think?

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EKG/ECG Shock Administration Emergency Department 84

ALiEM

FEBRUARY 9, 2024

Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG. The ACC 2022 pathway has a section dedicated to ECGs in ischemia [1], and FOAMcast has a great visual summary. below limit of detection) AND the chest pain onset is >3 hours ago AND the ECG is non-ischemic.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110