Dr. Smith's ECG Blog

JULY 5, 2024

A formal ultrasound later showed reasonably good LV function, and so he later received carvedilol and diltiazem, Unfortunately, those led to hypotension at 80/40 with a HR 40. Several hours later, this was the effect: NT pro-BNP elevated to 7000 Furosemide was also given.

Atrial Flutter 104

Atrial Flutter Tachycardia Atrial Fibrillation AFIB 104

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ). The November 4, 2018 post ( Leads V1,V2 misplacement ). When narrow (above His bundle), it is likely to be atropine responsive.

Chest Pain 86

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 86

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. Pads were placed with ultrasound guidance, so they were in the correct position. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. What to do now?

Tachycardia 141

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 141

Dr. Smith's ECG Blog

MAY 13, 2020

This was a point of care ultrasound, not a bubble contrast echo. Nevertheless, this ECG pattern of subendocardial ischemia needs to be instantly recognized — so that optimal decision-making based on the clinical scenario can promptly begin ( See the October 31, 2018 post on Dr. Smith’s Blog ). First trop I returns at 1.5.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. The January 30, 2018 post — for PTA. Smith comment: this is diagnostic of OMI until proven otherwise. The September 22, 2019 post — intermittent ST-T wave artifact.

Chest Pain 67

Chest Pain Blog Critical Care Arrhythmia 67

Dr. Smith's ECG Blog

JUNE 17, 2018

My Comment, by KEN GRAUER, MD ( 6/17/2018 ): = Excellent case with insightful learning points explaining why these serial tracings are not indicative of acute inferior infarction. Conclusion: 0 0 1 405 2312 MMRF 19 5 2712 14.0 I’ll add the following 2 comments: i ) This patient presumably has effusive-constrictive pericarditis.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

JUNE 20, 2018

Journal of Electrocardiology 2018. However, in almost every case, one should confirm absence of OMI (Occlusion MI) at least by contrast ultrasound. Journal of Emergency Medicine 2006; 31(1):67-77. 40-50% of LAD occlusion have zero reciprocal ST depression. 0 0 1 24 140 MMRF 1 1 163 14.0 That may be the case. Smith & Meyers.

Pericarditis 52

Pericarditis Chest Pain Blog Ultrasound 52

Dr. Smith's ECG Blog

MAY 19, 2020

The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. The authors recommend using optical coherence tomography or intravascular ultrasound imaging in patients with evidence of nonobstructive CAD by angiogram.

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion. Therefore, we performed ultrasound-guided pericardiocentesis. Is is sinus?

Chest Pain 40

Chest Pain Tachycardia Atrial Flutter Ultrasound 40

Dr. Paddy Barrett

NOVEMBER 7, 2023

You use an ultrasound. Metabolic Syndrome and Related Disorders , 2018; 6 Application of non-HDL cholesterol for population-based cardiovascular risk stratification: results from the Multinational Cardiovascular Risk Consortium. Regardless of the murmur findings they describe. Which can now be used easily at the bedside.

Cholesterol 52

Cholesterol Atherosclerosis Stenosis Aortic 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Many of these issues were described in a prior post by Dr. Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis.

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. A emergent cardiology consult can be helpful for equivocal cases.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr. Smith. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, QTc = 377 by computer 4-variable formula value = 16.2, There was good flow. It was stented.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

DAIC

MARCH 6, 2024

Food and Drug Adminstration (FDA) has approved DEFINITY (Perflutren Lipid Microsphere) as an ultrasound enhancing agent for use in pediatric patients with suboptimal echocardiograms, including those who have undergone heart transplant, or have Kawasaki disease or a congenital cardiovascular anomaly. Lantheus announced that the U.S.

Pediatrics 105

Pediatrics Ultrasound Heart Transplant Echocardiogram 105

Dr. Anish Koka

JULY 23, 2023

In 2018, he even opened a state of the art lab nicknamed “the Watcher” and was paid $18 million from Medicare in the next 3 years. A lower extremity arterial ultrasound revealed elevated velocities in the right proximal superficial femoral artery. 12.27.2016. Mr. Rosenberg meets Dr. Dormu.

Vascular Care 52

Vascular Care Outpatient Peripheral Arterial Disease Stents 52

Dr. Smith's ECG Blog

MARCH 15, 2023

Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. But when you see this, you should suspect that the AV node is not well. I signed her out to one of my partners.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

JUNE 2, 2023

My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG? J Electrocardiol, 42 (2009), pp.

Tachycardia 83

Tachycardia Cardiomyopathy Electrocardiogram Article 83

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

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. The patient's initial troponin I was 2.0 ng/mL (99% reference level = 0.030 ng/mL. With his ESRD, he does have an elevated baseline troponin at ~0.40

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

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. For another case in which marked ST elevation in leads V1 and V2 could easily be mistaken for a hyperacute change — See the Figure I drew in My Comment at the bottom of the December 27, 2018 post on Dr. Smith’s ECG Blog.

Chest Pain 40

Chest Pain Ischemia Angina Electrocardiogram 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Am J Cardiol 2018; 122(8):1303-1309. This was missed by the physicians, even with a bedside speckle tracking ultrasound: no wall motion abnormality was seen. In summary: At a cutpoint of 17.0, it is 97% sensitive. At a cutpoint of 19.0, it is 97% specific. Finally, there is a simplified formula without QT correction : Aslanger.

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Coronary Artery Disease Journal

JUNE 2, 2024

Methods We analyzed a cohort of patients admitted for ACS between February 2017 and February 2018. A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. The sensitivity of an NT-proBNP value more than 3647 was 88.9% (51.9–99.7%),

Heart Failure 40

Heart Failure Pulmonary Ultrasound Myocardial Infarction 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

A bedside cardiac ultrasound revealed grossly normal to hyperdynamic systolic function with no obvious areas of wall motion abnormalities. Heart Rhythm 2018. This was recorded about 30 minutes later: Same A previous ECG was obtained and was normal. His lab workup was significant for positive influenza A rapid test and hyponatremia.

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52