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Chest pain relieved by Maalox and viscous lidocaine by Stephen Smith Posted in: Blog Posts in Heart Health An otherwise health male in his early 40's presented with "burning" in his epigastrium that radiated to his throat and was relieved with Maalox and lidocaine.  He had an E ... Read on »
Beware confusing the diagnosis of posterior STEMI by using posterior leads... by Stephen Smith Posted in: Blog Posts in Heart Health Or at least understand their limitations!! This patient had chest pain and this ECG There is no significant ST elevation. But there is ischemic ST depressi ... Read on »
Resister for SMACC-Chicago! by Stephen Smith Posted in: Blog Posts in Heart Health All Don't forget SMACC Chicago 2015, June 23-26 (23rd is for workshops) Many of the workshops are already sold out, but there are some that you can still register for. ... Read on »
Subtle LAD Occlusion with Pseudonormalization of Wellens' Waves. by Stephen Smith Posted in: Blog Posts in Heart Health Here is another patient I saw a few weeks ago  He is in his 30's and presented with many hours of chest pain.  Here is his initial ECG The computerized QTc is 3 ... Read on »
It is Far too Early for a Requiem for Unstable Angina by Stephen Smith Posted in: Blog Posts in Heart Health Dr. Braunwald declared that high sensitivity troponins will make Unstable Angina a thing of the past.  That very well may be true, but in the United States we are not ye ... Read on »
I was reading a stack of ECGs yesterday, and saw this one, with no clinical information.... by Stephen Smith Posted in: Blog Posts in Heart Health I was reading a stack of ECGs yesterday, and saw this one, with no clinical information What do you think? (computerized QTc is 429 ms) See followup below. ... Read on »
Bilateral Arm and Mid Back Pain, BP 250/140, in a 50-something by Stephen Smith Posted in: Blog Posts in Heart Health A 50 something presented with 10/10 bilateral arm and pain between the shoulder blades that started at work.  It felt like a "tearing," and was associated with diaphoresis ... Read on »
Transient ST elevation, rules out for MI, what is it? by Stephen Smith Posted in: Blog Posts in Heart Health A 70 year old diabetic complained of 6/10 epigastric pain.  Here is his initial ECG There is diffuse ST elevation: II, III, aVF and V3-V6.  There is reciproca ... Read on »
A 50-something with severe chest pain and a normal ECG by Stephen Smith Posted in: Blog Posts in Heart Health A 50 something with no past history presented with sudden severe substernal chest pain with no radiation or associated symptoms.  The clinicians were very impressed with h ... Read on »
Wide Complex Tachycardia: Lewis Leads Do Not Differentiate VT from SVT with Aberrancy by Stephen Smith Posted in: Blog Posts in Heart Health An 83 yo complained of palpitations and dizziness and presyncope.  He had a history of systolic heart failure with an EF of 40-45% and h/o coronary stents.  He is on digox ... Read on »
20 year old woman with dizziness and hypotension by Stephen Smith Posted in: Blog Posts in Heart Health This is posted courtesy of Jaber Ibrahim Almajbri.  He posted it on Facebook EKG club and gave me permission to post it here. This 20 year old has hypotension, ... Read on »
An elderly man with severe chest pressure...... by Stephen Smith Posted in: Blog Posts in Heart Health This was sent to me by a medical student: The patient is an elderly man with no significant past medical history who developed what he describes as chest tightness thro ... Read on »
Male in early 40's with 1.5 hours of chest pain by Stephen Smith Posted in: Blog Posts in Heart Health A third year medical student sent me this ECG and asked for my interpretation: Recorded 0625 Here is what I wrote back:  "Tough one.  Probably is acute LA ... Read on »
Chest Pain and Right Bundle Branch Block by Stephen Smith Posted in: Blog Posts in Heart Health A male in late middle age with a history of RCA stent 8 years prior complained of chest pain.  EMS recorded the following ECG What do you see?  The computer rea ... Read on »
Is this acute STEMI? LV Aneurysm? Would you give Thrombolytics? by Stephen Smith Posted in: Blog Posts in Heart Health Recently I posted a case describing "Acuteness" on the ECG and how to assess whether it is too late for reperfusion, especially thrombolytics . This case was recently ... Read on »
Inspiratory Threshold Device Works if CPR is Adequate: New Evidence from ROC-PRIMED Trial by Stephen Smith Posted in: Blog Posts in Heart Health Re-Analysis of Data from the ROC-PRIMED Trial, presented at the AHA meeting in Chicago, shows that if CPR is done at the correct rate and depth, that the Inspiratory Thre ... Read on »
Acute Severe Pulmonary Edema and New LBBB, with Bedside Echo by Stephen Smith Posted in: Blog Posts in Heart Health A middle-aged woman had sudden pulmonary edema in the middle of the night.  There was no known history of left bundle branch block.  There was no chest pain. Her blood ... Read on »
What is the infarct artery? (Complex analysis, in this case) by Stephen Smith Posted in: Blog Posts in Heart Health This case was put on Twitter by Elisha Targonsky, who has a nice EM blog ( http://thechartreview.org ).  He provided it for posting here.  On Twitter, he asked for an anal ... Read on »
Is this inferor STEMI? by Stephen Smith Posted in: Blog Posts in Heart Health I received this ECG from a reader This is a very elderly female with chest discomfort and SOB.  Our interpretation was STEMI or demand ischemia. Is there inf ... Read on »
Read this ECG by Stephen Smith Posted in: Blog Posts in Heart Health What is the diagnosis here? The computer read was ****Acute STEMI****What is really going on? See Answer Below ... Read on »