2018, Cardiac Arrest and Ischemia - Cardiovascular Update

Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

JUNE 5, 2024

The ECG does not show any definite signs of ischemia. Uncontrolled coronary spasm may be associated with serious arrhythmias , including cardiac arrest ( Looi et al — Postgrad Med, 2012 ; Tan et al — Eur Heart J Case Rep, 2018 ; Chevalier et al — JACC, 1998 ; Rodriguez-Manero — EP Europace, 2018 ).

Chest Pain

Chest Pain Cardiac Arrest Blog Cardiomyopathy

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

Sudden shock with a Nasty looking ECG. What is it?

Dr. Smith's ECG Blog

MAY 3, 2024

When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). Suffice it to say that, "The heart does whatever it will do when a patient is about to arrest". There is STE in aVR.

Cardiogenic Shock

Cardiogenic Shock Cardiac Arrest Hospital Ischemia

ECG Blog #400 — Is this a NSTEMI?

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). To EMPHASIZE: This pattern of diffuse Subendocardial Ischemia does not suggest acute coronary occlusion ( ie, it is not the pattern of an acute MI ).

Blog

Blog Chest Pain Ischemia STEMI

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

Ischemia

Ischemia STEMI Stenosis Chest Pain

ECG Blog #383 — Is this Coronary Disease?

Ken Grauer, MD

JUNE 6, 2023

Part of the ST depression with deep T wave inversion in the lateral chest leads clearly reflects LV "strain" from the marked LVH — but despite the very large QRS amplitudes, this ST-T wave appearance looks disproportionate, suggesting at least a component of ischemia. The plan was to proceed as soon as possible with aortic valve replacement.

Blog

Blog Pulmonary Hypertension Aortic

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

Steve, what do you think of this ECG in this Cardiac Arrest Patient?" A woman in her 50s with dyspnea and bradycardia A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). HyperKalemia with Cardiac Arrest. 72; Issue 9; 2018. Is this just right bundle branch block?

Chest Pain

Chest Pain Bradycardia Cardiac Arrest STEMI

A Middle-Aged male with Chest Pain and an Unusual ECG

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

Chest Pain STEMI Ischemia Myocardial Infarction

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). In there ECG evidence of possible ongoing ischemia? (ie, IMPRESSION: I’d interpret this tracing as consistent with LVH and/or “strain” and/or ischemia. THANK YOU Dr. Lee!

Chest Pain

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

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 Published 2018 Feb 6. This in turn leads to an overall reduction in IL-6 production and CRP concentration.12 12 Colchicine, 0.5 34 Colchicine, 0.5 33,36,37 Colchicine, 0.5

Cardiovascular Disease

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease

A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

JULY 22, 2023

2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. 72; Issue 9; 2018 ) — A ) Brugada-1 ECG pattern, showing coved ST-segment elevation ≥2 mm in ≥1 right precordial lead, followed by a negative T-wave. — Heart Rhythm, 4(2), 198-199. [6]

Chest Pain

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Dr. Smith's ECG Blog

APRIL 15, 2019

If a patient presents with chest pain and a normal heart rate, or with shockable cardiac arrest, then ischemic appearing ST elevation is STEMI until proven otherwise. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

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

Arrhythmia Blog Chest Pain Cardiac Arrest

Young Man with a Heart Rate of 257. What is it and how to manage?

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

Meyers, Smith; Weingart wrote an extensive review on Idiopathic VT in the September 14, 2018 post of Dr. Smith’s ECG Blog. 14, 2018 post adds a series of PEARLS on “My Take” regarding this subject. As a result — it’s worth briefly reviewing this entity of “ Idiopathic ” VT. My Comment at the bottom of this Sept.

Tachycardia

Tachycardia Heart Disease Dysrhythmia Ablation

Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

JANUARY 30, 2019

2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Heart Rhythm, 4(2), 198-199. [6] Fever-related arrhythmic events in the multicenter survey on arrhythmic events in Brugada syndrome. Heart Rhythm, 15(9): 1394-1401. [7]

Heart Rhythm

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Fascinating case of dynamic shark fin morphology - what is going on?

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

Ischemia

Ischemia Arrhythmia Defibrillator Chest Pain

Normal angiogram one week prior. Must be myocarditis then?

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Sudden shock with a Nasty looking ECG. What is it?

ECG Blog #400 — Is this a NSTEMI?

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

ECG Blog #383 — Is this Coronary Disease?

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

A Middle-Aged male with Chest Pain and an Unusual ECG

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

A man in his 70s with weakness and syncope

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?

Young Man with a Heart Rate of 257. What is it and how to manage?

Hyperthermia and ST Elevation

Fascinating case of dynamic shark fin morphology - what is going on?

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