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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology. NEJM 362(9):779; March 4, 2009.

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ECG Changes in Intracranial Hemorrhage

All About Cardiovascular System and Disorders

Mechanism is thought to be due to sustained sympathetic stimulation, probably caused by dysfunction of insular cortex resulting in reversible neurogenic damage to the myocardium which could include contraction bands and subendocardial ischemia [2]. 2009 Nov;40(11):3478-84. Epub 2009 Aug 27. doi: 10.1161/STROKEAHA.109.556753.

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Abstract WMP115: Towards a Comprehensive Computational Model of Ischemic Stroke: Integrating Detailed Microvasculature With Advanced Model of Brain Tissue Metabolism

Stroke Journal

Results:Figure 2 shows timecourse of GLC, ATP, and Sodium in different compartments of the model through time in regions experiencing mild and severe ischemia. 2009 Dec 1;27(3):391 A physiologically accurate in silico model would provide a new route for study of the response to an ischemic event. T Ventimiglia et al. 2023;39:e37353.

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Precordial ST depression. What is the diagnosis?

Dr. Smith's ECG Blog

Precordial ST depression may be subendocardial ischemia or posterior STEMI. I have warned in the past that one must think of other etiologies of ischemia when there is tachycardia. Whether it is subendocardial ischemia or posterior STEMI, if you cannot get it to resolve, you must activate the cath lab. There is no ST elevation.

STEMI 52
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No, we can’t call OMT, as a re-vascularisation  procedure.

Dr. S. Venkatesan MD

Reference : Apart from the heavily quoted classics of COURAGE, BARI-2D, ISCHEMIA, ORBITA 1 etc. Regular exercise equivalent to PCI (ESC 2009).Will Please note ORBITA -2 is not an antidote to ORBITA-1) ,Read this 1.AVERT AVERT study :Atorvastatin equals PCI.2.Regular Will try to get the link for this soon.

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Which patient has the more severe chest pain?

Dr. Smith's ECG Blog

Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction [link] Abstract Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia.

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Abstract WP176: Hemoglobin Decrement is Associated With Ischemic Lesions on Brain MRI of Patients With Acute Intracerebral Hemorrhage

Stroke Journal

Though this association may be related to impaired cerebral oxygen delivery, it is unclear whether these changes relate to cerebral ischemia. Patients who had a brain MRI and serial hemoglobin measurements were included.