Differentiating Between Cardiac and Non-Cardiac Chest Pain
It is not always possible to be certain about the origin of chest pain just by its characteristics as the variation between individuals is quite a bit. A medical opinion should be sought in case of any significant chest pain so that important ailment is not missed. There can be a lot of overlap between symptoms due to heart disease and disease of other nearby organs.
Still some general observations are possible regarding chest pain originating from the heart. The typical pain of cardiac origin is a central chest pain which occurs on walking or other forms of exercise, known as effort angina. This pain is caused by insuffic...
Source: Cardiophile MD - April 10, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
A 29 year old male with chest pain, ST Elevation, and very elevated troponin T
By Magnus NossenThis ECG is from a young man with no risk factors for CAD, he presented with chest pain. How would you assess this ECG? How confident are you in your assessment? What is your next step? Note: lead format is CabreraI was sent this ECG in real time. The patient is a young adult male with chest pain. The chest pain was described as pressure like and radiation to both arms and the jaw. Symptoms were on and off. The pain was worse in the night and better when moving. The patient sought medical attention when the pain recurred for a second straight night accompanied by arm numbness as well as radiating pain. The ...
Source: Dr. Smith's ECG Blog - April 9, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
A man in his 50s with shortness of breath
Sent by Tom Fiero, written by Pendell Meyers A man in his 50s presented with acute shortness of breath. Unfortunately we do not have access to the patients presenting vital signs.Here is his ECG:Original image, suboptimal qualityQuality improved with PM Cardio digitizationThe 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. There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Thus...
Source: Dr. Smith's ECG Blog - March 26, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
Important Normal Values for ECG
Transcript of the video: Normal values for ECG will depend on the age, body size, gender, as well as the population being assessed. So there is a wide variation. Still, in a normal adult population, some normal values are useful, while assessing an ECG.
These are the normal waves which you expect on the ECG and normal heart rate in an adult is 60 to 100 per minute. P wave, the atrial activation, PR segment, QRS complex – ventricular activation, ST segment, and T wave, ventricular repolarization. Atrial repolarization wave is usually not seen in a standard surface ECG. It will somewhere in the ST segment (error: PR se...
Source: Cardiophile MD - March 25, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Evaluation of JVP
Transcript of the video: Now we will discuss the basic principles of evaluation of jugular venous pressure and jugular venous pulse. These are assessed in the internal jugular vein and not in the external jugular vein. To revise the anatomy lessons, this is the external jugular vein and this is the internal jugular vein. Now, why we should not be looking at external jugual vein, though it is much easier to find out is that, in lower portion, it may be kinked so that it may not reflect the true right atrial pressure. The whole purpose of assessing the jugular venous pressure and pulse is that it reflects the right atrial pr...
Source: Cardiophile MD - March 21, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Acute chest pain and ST Elevation. CT done to look for aortic dissection.....
Written byWilly FrickA 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. He had associated nausea, vomiting, and dyspnea.What do you think?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. Mistaking OMI for pericarditis is a much more harmful error than the converse. Still, in the interest of studying the ECG, here are some findings that could support pericarditis:Absence of large T-waves (flat ST segments)Absence of any STD in aVL (which is s...
Source: Dr. Smith's ECG Blog - March 9, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
Vomiting, Diarrhea, and " Bubbles in my Chest "
A 60-something complained of vomiting, diarrhea overnight, and " bubbles in my chest " that started just prior to calling 911.He had this ECG recorded prehospital:Smith interpretation:There are hyperacute T-waves in III and aVF, and reciprocal STD in aVL with a reciprocally inverted T-wave in aVL. There are also hyperacute T-waves in V3 and V4. There is STD in V1 and V2. So it appears to be diagnostic of OMI, but it is hard to figure out what exact territory and artery. It could be a proximal RCA with both inferior OMI, posterior OMI (pulling ST down in V1/V2), and RV OMI causing large ischemic...
Source: Dr. Smith's ECG Blog - February 12, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?
Written by Jesse McLaren Two patients
presented with acute chest pain, and below are the precordial leads V1-6 for
each. Patient 1 (ECG on the left) was a 45 year-old male, and patient 2 (ECG is
on the right) was a 70 year-old male. The limb leads have been removed because
there was no ST elevation in those leads, the QRS complexes have been
obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. Using the
current paradigm, can you tell which patient had an acute coronary occlusion? Using
T wave amplitude, can you tell which ECG has hyperacute T waves?...
Source: Dr. Smith's ECG Blog - January 17, 2024 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Noisy, low amplitude ECG in a patient with chest pain
Written by Colin Jenkins. Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. Edits by Willy Frick.A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. They had difficulty describing their symptoms, but complained of severe weakness, nausea, vomiting, headache, and chest pain. They denied fever, cough, dyspnea, and sick contacts. They described the chest pain as severe, crushing, and non-radiating. It was not wo...
Source: Dr. Smith's ECG Blog - January 15, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
Occlusion myocardial infarction is a clinical diagnosis
Written by Willy Frick (@Willyhfrick). Willy is a cardiology fellow with a keen interest in the ECG in OMI.A woman in her late 70s presented with left arm pain. The arm pain started the day prior when she was at the dentist ' s office for a root canal. Her systolic blood pressure at the dentist was over 200 mm Hg. She was given nitroglycerin which improved her blood pressure, and she completed the procedure. Her arm pain abated. The pain returned that evening and woke her from sleep. She eventually fell back asleep, and woke up feeling normal the next day (the day of presentation). After dinner the day of presentatio...
Source: Dr. Smith's ECG Blog - December 11, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.
Acute coronary syndrome in a pediatric patient?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. The patient was obese and had a medical history of only recurrent tonsillitis status post tonsillectomy and adenoidectomy but was otherwise healthy and fully vaccinated. He reported 1.5 days of chest pain that started as substernal and crushing in nature awakening him from sleep and occasionally traveling to right side of neck. The pain ...
Source: Dr. Smith's ECG Blog - December 5, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?
Written by Pendell MeyersTwo adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking " should we activate the cath lab? "What do you think? Here they are:Patient 1, ECG1:Zoll computer algorithm stated: " ***STEMI***, Anterior Infarct "Patient 2, ECG1:Zoll computer algorithm stated: " ST elevation, probably benign early repolarization... "Queen of hearts interpretations:Patient 1, ECG1:Patient 2, ECG1:Patient 1 Clinical Course and Outcome:The EM physician d...
Source: Dr. Smith's ECG Blog - November 29, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Brugada Syndrome: Diagnosis and Risk Stratification
Hello friends, this is the modified version of my talk at Indian Heart Rhythm Society Conference, New Delhi, 2023, on Brugada Syndrome. Hope you will enjoy this session.
Initial description of Brugada syndrome in 1992 was that of syncopal episodes and/or sudden death in persons with structurally normal heart and a characteristic ECG pattern of right bundle branch block with ST segment elevation in leads V1 to V3. Sometimes individuals with a diagnostic ECG may be totally asymptomatic and may be having a family history of sudden death. Genetic nature of the disorder and mutation in sodium channel gene was described in 1998...
Source: Cardiophile MD - October 27, 2023 Category: Cardiology Authors: Johnson Francis Tags: ECG / Electrophysiology General Cardiology Source Type: blogs
Does this T wave pattern mean anything?
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and SmithA 50-something-year-old female with a history of an unknown
personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return
of spontaneous circulation. The described rhythm was an irregular, wide complex
rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin. She was successfully revived
after several rounds of ACLS including defibrillation and amiodarone.On arrival to the ED the patient was intubated with normal vi...
Source: Dr. Smith's ECG Blog - October 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
What is the normal Pericardial thickness ?
An unusal conversation with a flamboyant student fellow,
May I know , What is the normal Pericardial thickness, ?
Which pericardium you mean sir ? ,Parietal or visceral?
Would like to know both .
It is variable sheet of tissue .You want the thinnest part or thickest part ?
Don’t beat around the bush .Tell some answer.
You want, autopsy thickness, or real life thickness as surgeon sees it ?
I want it in practical Imaging modality
Do you want Echo, CT or MRI thickness ?
I should say , its too much for a first-year fellow in reverse questioning!
Ok relax sir, shall I tell the systolic ...
Source: Dr.S.Venkatesan MD - October 20, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
