Dr Smith's ECG Blog

Dr Smith’s ECG Blog, by Stephen W. Smith

ECG Library (1128)

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Shark fin ST elevation LAFB RBBB Proximal LAD occlusion Dr Smith's ECG Blog CC BY-NC
Shark Fin morphology recognized only by EM physician 31940

This ECG is from a man in his 70s who complained of acute chest pain followed by a witnessed cardiac arrest. This ECG was taken after ROSC following 35 min down time.

This ECG shows Shark-fin morphology with RBBB + LAFB and massive anterolateral ST elevation. The cause was an acute proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Ta wave Sinus tachycardia Dr Smith's ECG Blog CC BY-NC
Look at this ST Depression 31938

This ECG is from a man in his 30s who presented with 2 days of chest heaviness

This ECG shows Sinus tachycardia with atrial depolarisation waves (Ta waves) mimicking ST depression.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Acute Inferior MI Acute Posterior MI Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
A man in his 70s with chest pain during a bike ride 31934

This ECG is from a man in his 70s who presented with chest pain that started during bike riding.

This ECG shows subtle ST depression in V2-6 and ST elevation in III. He had multi vessel disease with a near-occlusive culprit RCA lesion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Flat T waves Acute Lateral MI Dr Smith's ECG Blog CC BY-NC
Chest pain with NonDiagnostic ECG but Diagnostic CT Scan 31925

This ECG is from an elderly woman who presented with several hours of chest pain radiating to the back.

This ECG shows flat T waves in aVL but otherwise normal. Troponin was elevated. CT showed no dissection but an area of transmural ischemia. Serial ECGs showed no change. The cause was an occluded OM1.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Hypertension 12-Lead Discordant ST changes Tall QRS Wide QRS LBBB ST changes with LBBB Dr Smith's ECG Blog CC BY-NC
A 50-something woman with chest pain, BP 230/120, and LBBB with 7 mm ST Elevation 31864

This ECG is from a woman in her 50s who presented with chest pressure on a background of heart failure and hypertension. BP 223/125.

This ECG shows sinus rhythm, LBBB and anterior ST elevation. Sgarbossa positive but modified sgarbossa negative. Echo showed LVH, troponin did show a rise and fall, MIBI showed normal perfusion. The most likely cause was a type II MI. The ECG changes did not evolve and were likely baseline changes.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Serial 12-lead Biphasic T waves Wellens syndrome Serial ECGs & Dynamic Changes Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing: next morning 31948

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis. This was taken the next day after symptoms resolved.

This ECG shows biphasic T waves caused by Wellens' syndrome.

In the ECGquest archives, this ECG has been tagged with: - Chest pain Chest leads Anterior ST elevation Hyperacute T waves Terminal QRS distortion Normal vs. abnormal anterior ST elevation Dr Smith's ECG Blog CC BY-NC
A 40-something healthy male with transient chest squeezing 31836

This ECG is from a man in his 40s who presented with intermittent chest tightness, shortness of breath and diaphoresis.

This ECG shows ST elevation in V1-6 and hyperacute T waves out of proportion to the size of the QRS. There is terminal QRS distortion in V3. The cause was an acute proximal LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST depression Inferior ST elevation Wide QRS LPFB RBBB Acute Inferior MI Acute Posterior MI Dr Smith's ECG Blog CC BY-NC
Teach your learners: when the QRS is wide, the J-point will hide, so trace it down and copy it over! 31813

This ECG is from a middle aged man who presented with chest pain and diaphoresis while exercising. He had a VSD repair at age 6.

This ECG shows sinus tachycardia with RBBB + LPFB. ST elevation in III and aVF with reciprocal ST depression in aVL. ST depression in V2-5. The cause was inferoposterior MI, due to severe triple vessel disease and a culprit 100% circumflex occlusion.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Anterior ST elevation Pathological Q waves Old vs new ischemia Dr Smith's ECG Blog CC BY-NC
Unusual: Troponin Trajectory to Help Determine Ongoing/Recurrent Infarction vs. Completed Infarction. 31811

This ECG is from a man in his 40s who presented with a cough, shortness of breath and several episodes of chest pressure over the past week or so.

This ECG shows anterior ST elevation and deep QS waves. There was a 100% LAD occlusion that was approximately 2 weeks old.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Hyperacute T waves ST elevation in aVR Widespread ST depression Diffuse subendocardial ischaemia Dr Smith's ECG Blog CC BY-NC
Chest pain, pelvic and abdominal pain, hypotension, and severe ischemia on the ECG 31749

This ECG is from an elderly male who presented with lethargy and pelvic pain. He was hypotensive (66/31), pulse 80.

This ECG shows widespread ST depression and reciprocal ST elevation in aVR due to diffuse subendocardial ischemia. The most likely cause was septic shock.

In the ECGquest archives, this ECG has been tagged with: - Abdominal pain Chest pain 12-Lead Coved ST elevation Peaked T waves Tachycardia Wide QRS Sinus tachycardia Hyperkalemia Dr Smith's ECG Blog CC BY-NC
Do you recognize this ECG yet? 31724

This ECG is from a man in his 30s who presented with chest pain and RUQ abdominal pain, on a background of type 1 diabetes. His BSL was high.

This ECG shows sinus tachycardia with a wide QRS, R in aVR, coved ST elevation and peaked T waves. The cause was hyperkalemia.

In the ECGquest archives, this ECG has been tagged with: - Loss of consciousness 12-Lead Peaked T waves Short QT Dr Smith's ECG Blog CC BY-NC
What is the differential of this very unusual ECG? 31675

This ECG is from a young male who presented with a gun shot wound to the head.

This ECG shows tall peaked T waves and short QT. Potassium and calcium levels were normal. These findings are unusual but the cause may have been intracranial haemorrhage.

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