Dr. Smith's ECG Blog

AUGUST 3, 2017

Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. But the real question at hand is: Are these precordial ST-depressions a result of subendocardial ischemia?

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. Electrocardiol 45:433-442, 2012 ).

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. S. Venkatesan MD

MARCH 19, 2024

However, its refined version LMWH, though made it more palatable & user friendly, it un-apologetically took the sting out of regular heparin, made it less efficacious (more glamorous though) LMWH usage is in CAD widespread , it has suspect value* in true ongoing ischemia in any active ACS situation. 2012 May-Jun;54(3):207-15.

Heart Valves 52

Heart Valves Blood Clot Heart Disease Bicuspid/Mitral 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. Europace 2012 Shinde R, Shinde S, Makhale C, Grant P, Sathe S, Durairaj M, Lokhandwala Y, Di Diego J, Antzelevitch C. Occurrence of "J waves" in 12-lead ECG as a marker of acute ischemia and their cellular basis.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

EMS 12-Lead

JUNE 20, 2022

It’s important to stress the presence of a normal QRS (i.e., When the differential is LAD occlusion versus Normal Variant, use the formula as an assistive tool – only exercise extreme caution when reclassifying what you believe to be LAD occlusion as Normal Variant. With deliberate practice, spot diagnosis of T-to-R ratio will come with time.

Stent 52

Stent Stents STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 8, 2023

Annals of Emergency Medicine 2012; 60(12):766-776. EKG shown here: LAFB with no clear signs of OMI or ischemia. Diagnosis of Acute Myocardial Infarction in the Presence of Left Bundle Branch Block using the ST Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. No labs were performed. EKG and CT head were performed.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

MARCH 15, 2023

IF the Patient is Younger and Athletic: The mechanism of AFib in younger, athletic individuals is often heavily influenced by increased vagal tone ( Rao and Shipon — ACC, 2019 — and — Calvo et al — Br J Sports Med, 2012 ). To EMPHASIZE: The diagnosis of SSS requires ruling out other cause of inappropriately slow AFib i n the older patient.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

DAIC

JANUARY 3, 2024

Traditional methods of non-invasive ischemia testing (stress EKG , stress echo, SPECT , PET , direct-to-cath) can result in false negatives 20-30 percent of the time, which can lead to undetected disease, and false positives over 50 percent of the time, which can lead to unnecessary invasive procedures. Arbab-Zadeh, Heart Int 2012.

Coronary Artery Disease 59

Coronary Artery Disease Chest Pain Plaque Technology 59

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76

Tachycardia 98

Tachycardia Blog Sudden Cardiac Death Arrhythmia 98

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The pain will resolve and you will think the ischemia is gone when it is only hidden ! Smith comment: this troponin alone should be enough data to activate the cath lab, regardless of the ECG. Also: As we always say, do not give morphine until you are committed to the cath lab. Tikkanen, J. Wellens, H., & & Yan, G.-X. link] McGee, S.

Chest Pain 111

Chest Pain Myocardial Infarction Blog Stent 111

Dr. Smith's ECG Blog

JULY 22, 2023

These include ( among others ) — acute febrile illness — variations in autonomic tone ( as may occur with syncope ) — hypothermia — ischemia or infarction — cardiac arrest — and electrolyte disorders ( especially hyperkalemia — but also hypokalemia/hyponatremia ). Circulation, 117, 1890–1893. [3]: World Journal of Cardiology, 4(3): 84-86. [4]:

Chest Pain 64

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 64

Dr. Smith's ECG Blog

JANUARY 30, 2019

Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Circulation, 117, 1890–1893. [3]: 3]: Lamelas P, Labadet C, Spernanzoni F, Lopez Saubidet C, and Alvarez PA. Brugada electrocardiographic pattern induced by fever. World Journal of Cardiology, 4(3): 84-86. [4]: 4]: Antzelevitch C and Brugada R.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52