2018 Ischemia Ultrasound 
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. This was a point of care ultrasound, not a bubble contrast echo.
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?
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. Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis.
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 ). His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF.
Dr. Smith's ECG Blog
OCTOBER 24, 2018
This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. This was clearly severe subepicardial ischemia causing ST Elevation, but it was not of a long enough duration to result in measurable infarct. My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr. Smith.
Dr. Smith's ECG Blog
JUNE 20, 2018
I know from reading your blog that you "diagnose pericarditis at your own peril", but are there any signs on that initial ECG that would make you think ischemia? Journal of Electrocardiology 2018. However, in almost every case, one should confirm absence of OMI (Occlusion MI) at least by contrast ultrasound. ng/mL post PCI." "I
Dr. Smith's ECG Blog
FEBRUARY 6, 2020
ALL TROPS WERE UNDETECTABLE A formal ultrasound was done: Normal estimated left ventricular ejection fraction at rest. This ST-T wave appearance in the lateral chest leads of ECG #2 is consistent with L V “ S train” vs ischemia. The initial troponin returned undetectable. No wall motion abnormality at rest.
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