Category: Dr. Smith’s ECG Blog

Total eclipse of the heart

Written by Pendell Meyers A male in his late 50s had sudden chest pain radiating to the left side and back, with nausea and diaphoresis as well as bilateral finger tingling sensation. He drove himself to the Emergency Department. Here is his ECG on arrival at 11:33 am (unclear whether pain was persistent at this

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