2017, Ischemia and Myocardial Infarction

Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association

Circulation

NOVEMBER 13, 2024

This update summarizes relevant clinical data published since the 2017 American Heart Association scientific statement on KD related to diagnosis, cardiac imaging in acute KD treatment, and long-term management. Recent data have advanced the understanding of safety and dosing for several anti-inflammatory therapies in KD.

Aneurysm

Aneurysm Myocardial Infarction Cardiovascular Imaging Ischemia

HeartFlow Announces Revolutionary Five-Year Data Demonstrating a 63 Percent Mortality Reduction with FFRCT-Guided Care in PAD Patients

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. The 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS).”

Coronary Artery Disease

Coronary Artery Disease Chest Pain Myocardial Infarction Ischemia

Elucid Commences International PRE-VUE CCT Registry Study

DAIC

JULY 18, 2024

Cardiovascular disease is the most common cause of death and disability globally, largely driven by myocardial infarction and ischemic stroke caused by atherosclerosis (plaque build-up in the arteries). 2017 23, April 2020; Available from: [link]. Cardiovasc. 6 (3) (2019).

Plaque

Plaque Heart attacks Heart Attack Cardiovascular Disease

An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

OCTOBER 12, 2024

or basilar ischemia. 2017 Sep-Oct;50(5):561-569. Epub 2017 Apr 19. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. EKG on arrival to the ED is shown below: What do you think? However, T waves do not appear to be hyperacute or hyperkalemic. J Electrocardiol.

STEMI

STEMI Document Blog Ischemia

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

Troponin T peaked at 38,398 ng/L ( = a very large myocardial infarction, but not massive-- thanks to the pre-PCI spontaneous reperfusion, and rapid internvention!! ). There is no definite evidence of acute ischemia. (ie, Some residual ischemia in the infarct border might still be present.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

LAD 80% mid LCx occluded mid (acute infarct lesion) RCA 80% mid. PCI mid LCx So this is an OMI (Occlusion Myocardial Infarction), but not a STEMI Echo: Decreased left ventricular systolic performance, mild/moderate. Cardiac Troponin Changes to Distinguish Type 1 and Type 2 Myocardial Infarction and 180-Day Mortality Risk.

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

DAIC

JANUARY 23, 2024

3 Patients with ASCVD are at a higher risk for major adverse cardiovascular events (MACE) including heart attack or myocardial infarction (MI), stroke, and cardiovascular (CV) death.4 Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. 4 In the U.S. 12 Colchicine, 0.5 34 Colchicine, 0.5 N Engl J Med.

Cardiovascular Disease

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analys is.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Hypertrophic Cardiomyopathy

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

Cardiomyopathy Ischemia STEMI Coronary Angiogram

Syncope and Block

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. Comparison of the QRS complex, ST-segment, and T-wave among patients with left bundle branch block with and without acute myocardial infarction.

Heart Failure

Heart Failure Myocardial Infarction Bradycardia Chest Pain

Occlusion/reperfusion through 6 ‘normal’ ECGs

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

In the STEMI/NSTEMI dichotomy, NSTEMI is supposed to mean non-occlusive myocardial infarction, but this patient had transient Occlusion MI that was at risk for re-occlusion (like ‘transient STEMI’). Impact of total occluson of culprit artery in acute non-ST elevation myocardial infarction: a systemic review and meta-analysis.

STEMI

STEMI Myocardial Infarction Chest Pain Angina

Formula Utilization

EMS 12-Lead

JUNE 20, 2022

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

STEMI

STEMI Stents Stent Myocardial Infarction

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

Clinical questions : Is this an occlusion myocardial infarction and does the patient need the cath lab? 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. Heart Rhythm 2010 Hudzik B, Gasior M. J-waves in hypothermia.

STEMI

STEMI Bradycardia Arrhythmia Cardiac Arrest

A young peripartum woman with Chest Pain

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

Chest Pain SCAD STEMI Cardiogenic Shock

Of Twists and Turns

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] 2] Viskin, S., 3] Murphy, M.

Tachycardia

Tachycardia AFIB Coronary Artery Bypass Graft Arrhythmia

12 Example Cases of Use of 3- and 4-variable formulas, plus Simplified Formula, to differentiate normal STE from subtle LAD occlusion

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. J Electrocardiology 50(5):561-569; September/October 2017. This makes it almost certain that the ST elevation on the first one is due to ischemia. Annals of Emergency Medicine 2012;60:45-56.

Chest Pain

Chest Pain STEMI Bradycardia Stenosis

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. to 1.64) for myocardial infarction or death from coronary heart disease, and 1.06 (95 percent confidence interval, 0.77 Old myocardial infarction, 6. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia.

Arrhythmia

Arrhythmia Outcomes Risk Factors Chest Pain

Cardiovascular Update

Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association

HeartFlow Announces Revolutionary Five-Year Data Demonstrating a 63 Percent Mortality Reduction with FFRCT-Guided Care in PAD Patients

Elucid Commences International PRE-VUE CCT Registry Study

An elderly male with acute altered mental status and huge ST Elevation

What are treatment options for this rhythm, when all else fails?

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Hypertrophic Cardiomyopathy

Syncope and Block

Occlusion/reperfusion through 6 ‘normal’ ECGs

Formula Utilization

Unconscious + STEMI criteria: activate the cath lab?

A young peripartum woman with Chest Pain

Of Twists and Turns

12 Example Cases of Use of 3- and 4-variable formulas, plus Simplified Formula, to differentiate normal STE from subtle LAD occlusion

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

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