2018 Echocardiogram Ischemia 
Dr. Smith's ECG Blog
MAY 13, 2020
Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. What do you think the echocardiogram shows? NTG drip started. Pain better still.
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. See this case: what do you think the echocardiogram shows in this case? Anything more on history? POCUS will be helpful.” J Electrocardiol 2013;46:240-8 2.
Dr. Smith's ECG Blog
FEBRUARY 6, 2024
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Hopefully a repeat echocardiogram will be performed outpatient. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think? 1900: RBBB and LAFB are almost fully resolved.
Ken Grauer, MD
JANUARY 13, 2024
My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation." BOTTOM LINE: ECG changes of LV "strain" and/or ischemia that we see on today's initial ECG — were not present 9 years earlier. Cardiac cath showed normal coronary arteries.
Dr. Smith's ECG Blog
JULY 31, 2018
Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. It they are static, then they are not due to ischemia. 2012;5:134–137.
Dr. Smith's ECG Blog
FEBRUARY 6, 2020
Next day, a stress echo was done: The exercise stress echocardiogram is normal. This ST-T wave appearance in the lateral chest leads of ECG #2 is consistent with L V “ S train” vs ischemia. Normal estimated left ventricular ejection fraction improved with stress. No wall motion abnormality at rest.
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 ). I think a good start would be a posterior EKG and a high quality contrast echocardiogram read by an expert. In there ECG evidence of possible ongoing ischemia? (ie, THANK YOU Dr. Lee!
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