2019, Coronary Artery Disease and Ischemia

2019

Coronary Artery Disease

Ischemia

Abstract 4143007: Pericoronary fat attenuation index as a Novel Tool to predict the morbidity of new-onset atrial fibrillation in patients with myocardial infarction with nonobstructive coronary artery disease

Circulation

NOVEMBER 11, 2024

Background:Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronary artery imaging sign. Circulation, Volume 150, Issue Suppl_1 , Page A4143007-A4143007, November 12, 2024.

Coronary Artery Disease

Coronary Artery Disease Atrial Fibrillation Myocardial Infarction Ischemia

Abstract 262: National Trends of 90?day Readmission Rates and Etiologies among Diabetics following Transient Ischemic Attack

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionTransient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction. from 2016‐2019 and secondary diagnosis of T2DM. Diabetics were more likely to be younger (70.43

Diabetes

Diabetes Coronary Artery Disease Atrial Fibrillation Dementia

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).

Cardiogenic Shock

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

DAIC

JANUARY 23, 2024

Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 1,2 ASCVD causes or contributes to conditions that include coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease (inclusive of aortic aneurysm).3

Cardiovascular Disease

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease

The Advantages Of A CT Coronary Angiogram

Dr. Paddy Barrett

AUGUST 1, 2023

CT coronary angiography, in addition to a CT CAC, is arguably the best test for estimating whether someone has evidence of coronary artery disease and what that means for their near-term risk of a heart attack. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. N Engl J Med.

Coronary Angiogram

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain

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. Am J Med 2019, 132(5):622-630.

Ischemia

Ischemia STEMI Stenosis Chest Pain

Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging. What do you think?

Chest Pain

Chest Pain Ischemia Pacemaker Stent

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

Dr. Smith's ECG Blog

JULY 21, 2024

There is no definite evidence of acute ischemia. (ie, Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( If there had been ECG findings indicating reocclusion of the artery — an angiogram would have been warranted ).

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

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

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), or basilar ischemia. Preliminary findings documented in the cath lab were “Anterior STEMI and no significant coronary artery disease.” (!!!)

STEMI

STEMI Document Blog Ischemia

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Detailed coronary artery evaluation not performed. This suggests further severe ischemia.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. I believe this is by far the most common outcome for this patient around the world in 2019. So what will you do for this patient?

STEMI

STEMI Chest Pain Ischemia Myocardial Infarction

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): The Past, Present, and Future Management [Internet].

Plaque

Plaque Chest Pain Thrombosis Stenosis

A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

These findings are concerning for inferior wall ischemia with possible posterior wall involvement. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused. No significant changes, ongoing pain.

Chest Pain

Chest Pain Pulmonary ACE Inhibitor Pacemaker

Cardiovascular Update

Abstract 4143007: Pericoronary fat attenuation index as a Novel Tool to predict the morbidity of new-onset atrial fibrillation in patients with myocardial infarction with nonobstructive coronary artery disease

Abstract 262: National Trends of 90?day Readmission Rates and Etiologies among Diabetics following Transient Ischemic Attack

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

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

The Advantages Of A CT Coronary Angiogram

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

Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

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

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

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

What will you do for this patient transferred to you who is now asymptomatic?

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

A man in his 70s with chest pain during a bike ride

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