Stroke Journal

FEBRUARY 1, 2024

In this study, we aim to investigate the relationship between the number of MT passes at which successful recanalization is obtained and outcomes in LVO-related AIS patients with low ASPECTS.Methods:This retrospective cohort study was performed on the data from 31 thrombectomy-capable centers between 2013 to 2022.

Outcomes 40

Outcomes Stroke Strokes Hemorrhage 40

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

APRIL 22, 2022

Int J Cardiol 2013 2. We are told that the Stress Echo that was performed showed objective evidence of inducible ischemia ( confirmed apparently by both wall motion abnormalities and ECG changes ). Was this objective evidence of inducible ischemia accompanied by chest pain? Backus BE, Six AJ, Kelder JC, et al.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 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. Acute febrile illness. Hypothermia.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. There is 1 mm of ST segment elevation in lead aVR — which in the context of ST segment flattening in most other leads, suggests that there may be a component of subendocardial ischemia from underlying coronary disease. Detailed coronary artery evaluation not performed. Downstream vasospasm?

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

MARCH 22, 2022

There is no ischemia, certainly no concern at all for OMI. These ER patients did not have ischemia — and the variation in ST elevation was not related to either heart rate or QRS amplitudes ( Variation in ST-Segment Elevation in Early Repolarization: Electrocardiography 40:10,2007 ).

Blog 52

Blog Chest Pain Ischemia Arrhythmia 52

Ken Grauer, MD

JULY 22, 2023

Although this " Imbalance " of precordial T waves is not see n very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) , most often from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

Blog 78

Blog Chest Pain STEMI AFIB 78

Dr. Smith's ECG Blog

OCTOBER 20, 2013

This ECG is diagnostic of diffuse subendocardial ischemia. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR.

Cardiac Arrest 52

Cardiac Arrest STEMI Hemorrhage Hospital 52

DAIC

JANUARY 23, 2024

mg reduced the risk of cardiovascular death, MI or heart attack, ischemic stroke, or ischemia-driven coronary revascularization by 31% compared with placebo.34 2013;368(21):2004-2013. Published 2013 Apr 4. This in turn leads to an overall reduction in IL-6 production and CRP concentration.12 12 Colchicine, 0.5 N Engl J Med.

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

JUNE 30, 2023

And ECGs can change and evolve even when there is no ischemia. Although this is not a common phenomenon — You will see it on occasion ( See the July 24, 2013 post , among others — in Dr. Smith's ECG Blog ). LEARNING POINT : 1. Morphology matters. Pattern recognition is essential. AI does a great job at this but most humans do not.

Chest Pain 52

Chest Pain Blog Ischemia Document 52

Dr. Smith's ECG Blog

JUNE 1, 2020

COMPARE ECG #1 with ECG #2: I think the easiest way to make the case for Pleomorphic VT is to compare the 2 tracings in Figure-3: I took ECG #2 in Figure-2, from the October 12, 2013 post in Dr. Smith’s ECG Blog. Instead, antiarrhythmic drugs such as amiodarone or ß-blockers may be needed — and/or treatment targeted to correcting ischemia.

Tachycardia 52

Tachycardia AFIB Blog Heart Disease 52

Ken Grauer, MD

APRIL 29, 2023

The overall ST-T wave appearance in this lead looks more like LV “strain” than ischemia. ECG Blog #184 — illustrates the "magical" mirror-image opposite relationship with acute ischemia between lead III and lead aVL ( featured in Audio Pearl #2 in this blog post ). T waves are upright and peaked in anterior leads V1,V2,V3.

Blog 78

Blog Chest Pain STEMI Ischemia 78

Ken Grauer, MD

OCTOBER 27, 2023

This suggests ischemia of uncertain duration. Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT th e AV Blocks are — and what they are not ! There is deep, symmetric T wave inversion with a prolonged QTc interval in anterior leads V1,V2,V3.

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

Dr. Smith's ECG Blog

DECEMBER 16, 2019

Chest pain with New LBBB: It helps to actually measure the ST/S ratio A Fascinating Demonstration of ST/S Ratio in LBBB and Resolving LAD Ischemia The cath lab was activated. This was formerly an indication for cath lab activation, but was abandoned in the 2013 guidelines because of poor specificity. is worrisome!

Chest Pain 52

Chest Pain Myocardial Infarction Stents Stent 52

Dr. Smith's ECG Blog

JULY 22, 2023

This definition was changed following an expert consensus panel in 2013 — so that all that is currently needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Panel B in Figure-1 illustrates the Brugada Type-2 or “Saddle-back” ECG pattern.

Chest Pain 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

Dr. Smith's ECG Blog

JUNE 1, 2022

Here is his ECG: There is no clear evidence of OMI or ischemia. This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ).

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Bradycardia 52

Dr. Smith's ECG Blog

MAY 8, 2023

EKG shown here: LAFB with no clear signs of OMI or ischemia. 8 , 9 The most recent American College of Cardiology and American Heart Association ST-elevation myocardial infarction (STEMI) guidelines (2013) give no direction on diagnosing occlusion myocardial infarction in patients with ventricular paced rhythm. No labs were performed.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

2013 Sep;26(9):965-1012.e15. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. J Am Soc Echocardiogr. doi: 10.1016/j.echo.2013.06.023. 2013.06.023. PMID: 23998693. Appleton C, Gillam L, Koulogiannis K. Cardiac Tamponade. Cardiol Clin. 2017 Nov;35(4):525-537.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

There is no ST depression in V6, II, III, or aVF, and no significant ST elevation in aVR, all confirming that the ST vector is not consistent with diffuse subendocardial ischemia, but rather a focal ST vector pointed at the posterior wall. There is sinus rhythm with normal QRS complex and ST depression in V2-V5, maximal in V3-V4.

STEMI 52

STEMI Chest Pain Myocardial Infarction Document 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

Ischemic ST-segment depression maximal in V1-V4 (versus V5-V6) of any amplitude is specific for Occlusion Myocardial Infarction (versus nonocclusive ischemia). Arch Cardiovasc Dis 2013 Khan AR et al. JAHA 2022 Grosmaitre P et al.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

EMS 12-Lead

APRIL 2, 2022

Below is a refresher on appropriate precordial lead placement. [6] 6] A more robust examination of lead malposition can be found at the Emergency Medicine Cases website by the great Dr. Jesse McLaren. link] Also, do not miss Dr. Grauer's great explanations on -- LAFB [link] RBBB-LBBB-IVCD [link] LBBB-Sgarbossa-LVH-MI [link] [1] Ravi, S.,

Myocardial Infarction 52

Myocardial Infarction Stent Stents STEMI 52

Dr. Smith's ECG Blog

MAY 5, 2022

This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Panel B in Figure-5 illustrates the Brugada Type-2 or “Saddle-back” ECG pattern.

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Stroke Journal

FEBRUARY 1, 2024

Objective:To investigate the treatment outcomes of MT in tVBO.Method:This international, multicenter, retrospective cohort included patients with MT for tVBO and isolated BAO from 2013 to 2023. Secondary outcomes included complete recanalization (modified Thrombolysis in Cerebral Ischemia [mTICI] ≥ 2C) and 90-day mortality rate.

Outcomes 40

Outcomes Thrombolysis Ischemia Stroke 40

Dr. Smith's ECG Blog

JANUARY 9, 2025

Doesn't this necessarily mean that he was having ischemia? Although this is not a common phenomenon You will see it on occasion ( See the June 30, 2023 post the November 27, 2023 post and the July 24, 2013 post in Dr. Smith's ECG Blog ). What does the Queen of Hearts think? "No Unfortunately, life is not so simple.

Chest Pain 106

Chest Pain Ischemia Dysrhythmia Arrhythmia 106

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Denying patients the potential benefit of revascularization just because their symptoms have lasted a certain amount of time shows poor understanding of the pathophysiology of myocardial ischemia. There were no other causes of dyspnea apparent and thus we can assume that myocardial ischemia started 6 days prior. link] [2] Oliva, P.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Ken Grauer, MD

MARCH 8, 2025

Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT the AV Blocks are and what they are not ! ECG Blog #184 illustrates the " m agical" m irror- i mage o pposite relationship with acute ischemia between lead I II and lead a VL.

Blog 105

Blog STEMI Download Chest Pain 105

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Here is the final angiogram following placement of a stent in the ostial RCA. SanzRuiz, R., Solis, J., & & FernndezAvils, F.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75