Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. 2016, April 13). Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think? In patient's at risk, physical activity should be limited for several months after the injury. Zangouri, V.,

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Stroke Journal

JANUARY 30, 2025

We performed this analysis to identify the prevalence of atrial fibrillation and associated outcomes in symptomatic internal carotid artery stenosis patients undergoing CAS or CEA.Methods:We analyzed the data from the National inpatient sample (NIS) between January 2016 to December 2021. versus 18.8% for CAS or CEA, respectively, p=0.50].

Atrial Fibrillation 40

Atrial Fibrillation Stents Stent Outcomes 40

Dr. Smith's ECG Blog

APRIL 30, 2024

Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? He was resuscitated into a perfusing rhythm. He went in and out of arrest until arrival at the ED.

Blog 108

Blog Ischemia Tachycardia Arrhythmia 108

All About Cardiovascular System and Disorders

APRIL 13, 2024

ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due to transmural ischemia of the basal part of the septum. 2016 Sep;68 Suppl 2(Suppl 2):S226-S227. 2016; 6:49-51. Injury current of basal part of septum is directed towards right shoulder and aVR. References Sen F et al. Indian Heart J.

Stenosis 52

Stenosis Coronary Artery Bypass Graft Coronary Artery Disease Document 52

BoardVitals - Cardiovascular

SEPTEMBER 29, 2017

The images demonstrate a moderately extensive, mildly severe reversible defect in the mid and distal anterior/anterolateral wall consistent with ischemia. Which of the vessels is likely the culprit vessel causing the ischemia? The pass rate for the nuclear cardiology examination in 2016 was 82%.

Chest Pain 52

Chest Pain Certification Ischemia General Cardiology 52

Stroke Journal

FEBRUARY 1, 2024

We explored whether major ABO incompatible platelet transfusions are associated with these ischemic lesions.Methods:Consecutive spontaneous ICH patients enrolled into a single-center, prospective cohort study between 2009 and 2016 were assessed. Major ABO incompatible platelet transfusion was the exposure. 217.94, p = 0.03).Conclusions:Major

Hemorrhage 40

Hemorrhage Ischemia Risk Factors Outcomes 40

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

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

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. J Nucl Cardiol 2016. NEJM 2010.

Coronary Artery Disease 59

Coronary Artery Disease Chest Pain Plaque Technology 59

Dr. S. Venkatesan MD

FEBRUARY 20, 2024

N Engl J Med 2016; 375:1221-1230) Why ICD doesn’t work well in NDCM ? The simple reason could be we can address the ischemia a potential arrhythmic target by some form of revascularization in IDCM. 2016 Sep 29;375(13):1221-30. SCD-HeFT trial (NEJM 2005) did show some benefits in N-DCM, but it was only in class 2 stage.

Defibrillator 52

Defibrillator Heart Failure Sudden Cardiac Death Cardiomyopathy 52

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. Shanghai Score was arrived at in a consensus conference held in 2016. 2016 Oct;13(10):e295-324.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

EMS 12-Lead

APRIL 8, 2022

When “spot diagnosing” precordial ST-depression I instinctively evaluate aVR for any corresponding ST-elevation to see if an emerging pattern of broad subendocardial ischemia can be appreciated, in which the ST-depression should be otherwise global and demonstrably maximal in Leads II and V5. ST-elevation, etc.) is present. 1] Driver, B.

Myocardial Infarction 52

Myocardial Infarction Coronary Angiogram STEMI Ischemia 52

Dr. Smith's ECG Blog

JULY 27, 2023

hours ECG: Not much change hs troponin I peaks at 500 ng/L 8 hours Next morning Urine drug screen: Amphetamine, Methamphetamine, Fentanyl, Fentanyl metabolite Formal Bubble Contrast Echocardiogram: Indications for Study: Silent Ischemia. SUMMARY Normal left ventricular cavity size. Normal estimated left ventricular ejection fraction.

Tachycardia 52

Tachycardia Ischemia Cardiac Arrest Echocardiogram 52

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. Lead V2 shows RR’ QRS configuration, and although ST depression is otherwise expected here, the discordance is a bit excessive. 3] Meyers, H.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Methods : The PERFECT study (#NCT02765477) is a retrospective, 16 center, international investigation of ED patients from 1/2008 - 12/2016 with VPR on the ECG and symptoms of acute coronary syndrome (ACS). We hypothesized that the MSC will have higher sensitivity for diagnosis of ACO in VPR when compared to the original Sgarbossa criteria.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

This strongly suggests reperfusing RCA ischemia. Troponins, echocardiogram An echocardiogram showed inferobasilar hypokinesis, further supporting a diagnosis of regional ischemia , likely of the area supplied by the RCA. There is also a Q-wave in III. There is also subtle STD in V3-V5. The initial troponin I was elevated at 0.75

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

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 ). Prognostic significance of fever-induced Brugada syndrome.

Chest Pain 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

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. Journal of Emergency Medicine 2016. The average highest ST/S ratio in V1-V4 for a normal LBBB is about 0.11. is worrisome! The LAD was 100% occluded.

Chest Pain 52

Chest Pain Myocardial Infarction Stents Stent 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

References: [1]: Mizusawa Y, Morita H, Adler A, Havakuk O, Thollet A, Maury P, Wang DW, Hong K, Gandjbakhch E, Sacher F, Hu D, Amin AS, Lahrouchi N, Tan HL, Antzelevitch C, Probst V, Viskin S, Wilde AA. Prognostic significance of fever-induced Brugada syndrome. Heart Rhythm, 13(7): 1515-1520. [2]:

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiac arrest — and especially Hyperkalemia. Patients with such conditions that may transiently mimic the ECG findings of a Brugada-1 pattern are said to have Brugada Phenocopy.

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

EMS 12-Lead

APRIL 2, 2022

& Knilans, T. Chapter 6: Other Intraventricular Conduction Disturbances. Chou’s Electrocardiography in Clinical Practice, 6th ed. 3] Smith, S. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. American Journal of Emergency Medicine, 34 (11), 2182-2185. [4] 4] Baranchuk, A, et al.

Myocardial Infarction 52

Myocardial Infarction Stents Stent STEMI 52

Stroke Journal

JANUARY 30, 2025

Background:According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhages (SAH), early treatment of ruptured aneurysms reduces the risk of repeated bleeds and facilitates treatment of delayed cerebral ischemia.

Aneurysm 40

Aneurysm Hospital Outcomes Strokes 40

Dr. Smith's ECG Blog

MARCH 6, 2020

There is no evidence of infarction or ischemia. N OTE : I begin with Figure-1 — in which I show 3 examples of R egular S VT r hythms , in which sinus P waves ( ie, upright P waves in lead II ) are not seen: E CG # 1 in Figure-1 is from the October 31, 2016 post on Dr. Smith’s Blog. There are nonspecific ST-T abnormalities.

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Frontiers in Cardiovascular Medicine

NOVEMBER 21, 2024

BackgroundAnomalous aortic origin of a coronary artery (AAOCA) is associated with an increased risk of myocardial ischemia and sudden cardiac death. ResultsThe median age at surgery was 26 years (range, 13–57 years). ResultsThe median age at surgery was 26 years (range, 13–57 years).

Aortic 52

Aortic Sudden Cardiac Death Angioplasty Outcomes 52

Dr. S. Venkatesan MD

FEBRUARY 3, 2025

Suddenly, as I finish writing this, a big fact struck me hard , i.e., even a well-done PCI in sophisticated core labs with meticulous care struggled to beat OMT in a barrage of landmark trials (like COURAGE, ISCHEMIA, ORBITA). 2016 Dec;9(12):e003726. What is the big deal to analyze suboptimal PCI vs OMT?

Stents 52

Stents Stent Academic Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

But it also shows a massive area of total ischemia in the LAD territory: CT shows the infarct The CT is with contrast, which increases density (which looks more white). Most dissections which cause coronary ischemia are into the RCA ostium ("ostium" = locations of takeoff of the vessel). No ECG was recorded after pain resolution.

Chest Pain 105

Chest Pain Aortic STEMI Ultrasound 105

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. In 2016, I doubled the number of night shifts and suddenly was having 10,000 PVCs per day, very distressingly symptomatic. You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion.

Tachycardia 72

Tachycardia Arrhythmia Ablation Atrial Flutter 72