Category: Dr. Smith’s ECG Blog

The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock

A 60-something presented with hypotension, bradycardia, chest pain and back pain. She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3.  She was ill appearing.  BP was 70/49, pulse 60. A bedside

Large T-waves and a Computer Interpretation of ***Acute MI***

This ECG was texted to me with no information: I answered: “Show me the whole 12-lead.” Here it is: Computer Interpretation: SINUS RHYTHMINFERIOR MYOCARDIAL INFARCTION, POSSIBLY ACUTEST ELEVATION, CONSIDER ANTERIOR INJURY [MARKED ST ELEVATION W/O NORMALLY INFLECTED T WAVE IN V2-V5] ***ACUTE MI*** What do you think? This was my answer, in which I suspected

Was the intern correct?

Written by Pendell Meyers, case submitted by Max Macbarb, edits by Steve Smith A 71 year old gentleman with history of CAD and PCI presented with acute chest pain and normal vitals signs.  He was triaged to the general area of the emergency department after an initial review of this ECG by a senior resident

Thrombus propagation on 10 serial Prehospital ECGs: Can you explain the progression?

This patient called 911 for chest pain.  The medics did an amazing job of recording serial ECGs. Time zero Hyperacute T-wave and subtle STE in aVL with Reciprocal ST depression (with reciprocally hyperacute T-waves!) in inferior leads.ST depression in V3-V6 typical of diffuse subendocardial ischemia. High lateral STEMI [typical of circumflex or first diagonal (D1) occlusion]? 

Two cases texted to me for concern of inferior hyperacute T waves and a flipped T in aVL – do either, neither, or both need emergent reperfusion?

Written by Pendell Meyers I received two texts recently, in both cases the practitioners were worried about possible inferior hyperacute T-waves with an inverted T-wave in aVL. I was not given any clinical history. What would you tell the team in these two cases? Case 1 Case 2 My responses: Case 1: “Not hyperacute. The