Dr. Smith's ECG Blog

OCTOBER 18, 2023

A majority (62.5%) of those presenting with ‘normal’ ECGs had the cath lab activated without any ECG being labeled ‘STEMI’ by automated interpretation – based on signs of Occlusion MI including ECG changes, regional wall motion abnormality on bedside ultrasound, or refractory ischemia. 2017 ; 24 ( 1 ): 120 - 124 2. Acad Emerg Med.

Chest Pain 119

Chest Pain STEMI Electrocardiogram Ischemia 119

EMS 12-Lead

MAY 20, 2022

There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This is the initial ECG: The QRS is widened with a regular cadence, and there are no discernable P waves.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is normal R-wave progression in the precordial leads with no evidence of ischemia. 21, 2017 ). Here the image quality is enhanced using the PM Cardio app. What do you think? The presenting ECG shows SR with narrow QRS complexes.

Pulmonary 116

Pulmonary Tricuspid Chest Pain Cardiogenic Shock 116

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionPituitary apoplexy is a serious, emergent, and potentially dangerous condition of the pituitary in which the gland is affected by hemorrhage and/or ischemia typically in the setting of an underlying adenoma. Rutkowski’s 2017 study was the only to assess outcomes prior to versus after intervention at the 72 hours timepoint.

Outcomes 40

Outcomes Ischemia Hemorrhage Strokes 40

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

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. 2017 Jun 6;69(22):2692-2695.

Heart Valves 52

Heart Valves Blood Clot Heart Disease Bicuspid/Mitral 52

EMS 12-Lead

JUNE 20, 2022

It’s important to stress the presence of a normal QRS (i.e., Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction. Annals of Emergency Medicine, 60 (1), 45-56. 2] Driver, B.

STEMI 52

STEMI Stent Stents Myocardial Infarction 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

NOVEMBER 28, 2022

2017 Nov;35(4):525-537. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. The above said — Electrical alternans is a nonspecific ECG sign that may also indicate myocardial ischemia, LV dysfunction and/or possibility of any of a number of other precipitating factors.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

DECEMBER 27, 2018

JACC 69(23):1694-1703; April 4, 2017. S-wave is in V2 = 17 mm S-wave V4 = 9 mm Total = 26 (not greater than 28), so not LVH by the new rule! Nevertheless, it has the look of LVH. Peguero JG et al. Electrocardiographic criteria for the diagnosis of left ventricular Hypertrophy. Still, sensivity was only 62%, with greater than 90% specificity.

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

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). Eur Heart J 2017 Driver BE, Shroff GR, Smith SW. JAHA 2022 Grosmaitre P et al. Arch Cardiovasc Dis 2013 Khan AR et al. Emerg Med J 2017;34(2):119–23.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

J Electrocardiology 50(5):561-569; September/October 2017. To me, this makes the ECG nearly diagnostic of ischemia, though if it is LAD occlusion, there should be ST depression in III and aVL, so it is a bit confusing. This makes it almost certain that the ST elevation on the first one is due to ischemia. the more accurate.

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

DAIC

MAY 8, 2024

6 This novel study marks a significant milestone in the field, evaluating the effectiveness of FFR CT in detecting ischemia-producing coronary stenosis in patients with severe PAD. Diagnosis and treatment of ischemia-producing coronary stenoses improves 5-year survival of patients undergoing major vascular surgery.” 2024, [link].

Coronary Artery Disease 111

Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

DAIC

JULY 18, 2024

The company is also pursuing an indication for non-invasive measurement of fractional flow reserve (FFR CT ), uniquely derived from its plaque algorithm, to measure coronary blockages and the extent of ischemia. 2017 23, April 2020; Available from: [link]. Cardiovasc. 6 (3) (2019).

Plaque 105

Plaque Heart Attack Heart attacks Cardiovascular Disease 105

Dr. Smith's ECG Blog

JUNE 23, 2024

This was interpreted by the treating clinicians as not showing any evidence of ischemia. This is a critically important determination because of the 2017 AHA/ACC/HRS Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Here is his presenting ECG: ECG 1, t = 0 What do you think?

Chest Pain 118

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

Dr. Smith's ECG Blog

AUGUST 10, 2023

Even though they were passed the 12 hour mark traditionally associated with reperfusion benefits, ongoing ischemia requires emergent angiogram On assessment, the patient appeared uncomfortable, leaning forward in his chair. ACS with refractory ischemia and electrical instability are indications for emergent cath regardless of the ECG!

Chest Pain 98

Chest Pain STEMI Ischemia Nursing 98

Dr. Smith's ECG Blog

JULY 21, 2024

There is no definite evidence of acute ischemia. (ie, Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( Some residual ischemia in the infarct border might still be present. Both episodes are initiated by an "R-on-T" phenomenon.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

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 113

Tachycardia Blog Sudden Cardiac Death Arrhythmia 113

Dr. Smith's ECG Blog

JULY 22, 2023

For now, the 2017 AHA/ACC/HRS guidelines for asymptomatic patients that have inducible types of Brugada syndrome recommend observation without any specific therapies or interventions [8]. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.

Chest Pain 91

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 91

Stroke Journal

JANUARY 30, 2025

However, the mechanisms underlying brain ischemia in DE are not well understood. Background:Dolichoectasia (DE) is characterized by the abnormal dilation and elongation of brain arteries, leading to high morbidity and mortality, commonly presenting as ischemic stroke.

Stroke 40

Stroke Strokes Stenosis Ischemia 40

Dr. Paddy Barrett

DECEMBER 5, 2023

The ORBITA trial published in 2017 attempted to answer this question by taking people with significant narrowing of a coronary artery and then randomising them to either medications alone in addition to a sham procedure or medications plus stenting 2. Subscribe now 1 ISCHEMIA Research Group. N Engl J Med. 2020 Apr 9;382(15):1395-1407.

Stents 59

Stents Stent Angina Heart Attack 59

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. 2017 Mar;110(3):188-195. J Cardiovasc Electrophysiol. 2020 Sep;31(9):2474-2483. Arch Cardiovasc Dis.

Sudden Cardiac Death 52

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

For now, the 2017 AHA/ACC/HRS guidelines for asymptomatic patients that have inducible types of Brugada syndrome recommend observation without any specific therapies or interventions [8]. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

BMJ 2017;359:j4788 doi: 10.1136/bmj.j4788 (Published 2017 November 07) Full text link: [link] Abstract Objective To evaluate how selection of patients for high sensitivity cardiac troponin testing affects the diagnosis of myocardial infarction across different healthcare settings. Sandoval Y et al.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 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. 2] Meyers, H.

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

DAIC

JANUARY 23, 2024

12,16 In 2017, CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) provided proof-of-principle that inflammation inhibition in the absence of lipid lowering can significantly reduce cardiovascular event rates and helped to define the interleukin-1 (IL-1) to IL-6 to CRP pathway as a central target in CV disease.16

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

EMS 12-Lead

APRIL 28, 2022

In most cases, rather, the culprit is gross ischemia due to myocardial infarction, cardiomyopathy, or advanced coronary artery disease. Unfortunately, today’s case is lacking any such diagnostics, thus I cannot say with certainty that the QT interval is, or is not, culpable in arrhythmogenesis. [1] Wolters-Kluwer: Philadelphia, PA. [2]

Tachycardia 52

Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

European Heart Journal 38(41):3082-3089; November 1, 2017. There is no way the ST-T wave should change from lead V4-to-V5 as we see here given the similar all negative QRS appearance in these 2 leads, unless there is acute ischemia. These include disproportionately large upright and negative T waves in leads V2 and V6, respectively.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia. And these findings come from OESIL , EGSYS , and Sarasin studies: i: Non-sinus rhythm ii: SVT or VT (obviously, and this makes for an abnormal vital sign anyway) iii. Left BBB vi. LVH or RV d.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

MARCH 25, 2025

There is low voltage in the precordium which always makes reading ischemia harder. In ACS, chest pain is the warning sign of ongoing ischemia. Smith : As Willy says, and as we've said many times before, morphine will resolve pain without resolving ischemia. ECG 1 What do you think? To me, this ECG is not diagnostic.

Chest Pain 63

Chest Pain Ischemia Plaque Stent 63

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

There is ST elevation in 9/12 leads with ST depression only seen in lead aVR>V1 ( ie, virtually the opposite of what is seen with diffuse subendocardial ischemia in which there is diffuse ST depression except for ST elevation in aVR>V1 ).

STEMI 87

STEMI Hemorrhage Cardiac Arrest Tachycardia 87

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.

Chest Pain 88

Chest Pain Pericarditis Myocardial Infarction Dementia 88

Dr. Smith's ECG Blog

JANUARY 21, 2023

CMAJ 2017 Vassallo SU, Delaney KA, Hoffman RS, et al. Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. Occurrence of "J waves" in 12-lead ECG as a marker of acute ischemia and their cellular basis. Heart Rhythm 2010 Hudzik B, Gasior M. J-waves in hypothermia.

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52