Category: Dr. Smith’s ECG Blog

A Simplified Formula Discriminating Subtle Anterior Wall Myocardial Infarction from Normal Variant ST-Segment Elevation

Dr. Emre Aslanger has published a simpler formula for differentiating electrocardiographically subtle LAD occlusion from normal variant ST elevation. Here is the paper:Aslanger E et al.  A Simplified Formula Discriminating Subtle Anterior Wall Myocardial Infarction from Normal Variant ST-Segment Elevation. American Journal of Cardiology.  https://doi.org/10.1016/j.amjcard.2018.06.053https://www.sciencedirect.com/science/article/pii/S0002914918314206 Here is the simplified 4-variable formula:(R-wave amplitude in lead V4 + QRS amplitude in

A Middle-Aged Man with Blunt Trauma and Hemopericardium

A Middle-Aged man had a single vehicle motor vehicle collision with significant energy. He was hypotensive upon arrival. A bedside ultrasound was done immediately.  Here are 3 clips. There is pericardial fluid with echogenic material, diagnostic of hemopericardium with thrombus. An ECG was recorded: What do you think? Sinus tachycardia.  There are Q-waves in II,

“Are these hyperacute T-waves?” – what is your recommendation for the team in these two cases?

Written by Pendell Meyers, edits by Steve Smith When practitioners are learning a new ECG concept for the first time, they very appropriately must go through a stage where they titrate their mind to the new finding, going through stages of over and under-recognizing. In my experience this is a normal phenomenon in all of

An athletic 30-something woman with acute substernal chest pressure

Post by Smith, with short article by Angie Lobo (https://twitter.com/ALoboMD), a third year intermal medicine resident at Abbott Northwestern Hospital CaseA 30-something woman with no past history, who is very fit and athletic, presented with 1.5 hours of substernal chest pressure.  It was non-radiating and without other associated symptoms except for nausea.  She had zero CAD risk factors. Here

Chest pain and T-wave inversion in lead V2

This is the ECG of a young man who complained of chest pain. Here is the computer interpretation:ATRIAL FLUTTER/TACHYCARDIA (this is obviously incorrect)LEFT POSTERIOR FASCICULAR BLOCK [QRS AXIS greater than 109, INFERIOR Q]MODERATE ST DEPRESSION [0.05+ mV ST DEPRESSION]ABNORMAL ECGI saw the ECG before seeing the patient, indeed before he was even in his room.  I