Dr. Smith's ECG Blog

DECEMBER 19, 2023

Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. The image on the left shows the LAD before intervention, and the red circled portion on the right indicates the stented region.

Plaque 127

Plaque Angina Blog Stent 127

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionThe 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. We analyze the national trends in mechanical thrombectomy use and outcomes for stroke five years after publication of the US guideline update.MethodsWe analyzed the National Inpatient Sample from 2012‐2019.

Stroke 40

Stroke Strokes Cardiac Arrest Inpatient 40

Dr. Smith's ECG Blog

AUGUST 6, 2024

This led to immediate cath lab activation — which revealed total occlusion of a large 1st diagonal branch that was stented. == Below is the ECG of Patient #3 — recorded from a 35-year old man with sudden, new-onset CP. In a word — Patient #2 was lucky to have his ECG interpreted by the Queen Of Hearts.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

At that visit the patient was found to have an in-stent RCA occlusion. The patient was referred emergently to the cath lab, and again there was an in-stent RCA occlusion. In fact, this patient had an extensive hx of prior MIs. The ECG (ECG#2) on file that was given you was obtained three months prior. Troponin I peaked at 18.323ng/L.

Chest Pain 111

Chest Pain Pacemaker Ischemia Stent 111

Stroke Journal

JANUARY 30, 2025

The studies were classified in 3 periods by publication date: Period 1: before 2015, pre-stent retriever; Period 2: 2015-2019, early thrombectomy era; and Period 3: 2020-2024, recent period.Results:Of 2693 references, 21 trials met inclusion criteria, 3 in Period 1, 10 in Period 2, 8 in Period 3.

Stroke 40

Stroke Strokes Stent Stents 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

first reported 3 patients with vertebral webs diagnosed by DSA and having MRI show ischemic strokes in the vascular territory were treated with endovascular stenting and had no recurrence of an ischemic event (4). Lenck et al.

Stroke 40

Stroke Strokes Stent Stents 40

American College of Cardiology

FEBRUARY 1, 2025

7 The use of antiplatelet agents to prevent stent thrombosis, moderate- to high-dose statin therapy after acute coronary syndromes, or antihypertensive agents in asymptomatic patients may all be perceived by patients as not providing benefit because they may not feel the effects.8

Cardiovascular Disease 40

Cardiovascular Disease Coronary Artery Disease CMS Hospital 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Two adjunctive modifications of CE ‐ balloon remodeling techniques (BRT) and stent‐assisted coiling (SAC) ‐ have been utilized to facilitate occlusion of BTAs of variable anatomies/morphologies, sizes, and rupture status. Stents approved by FDA after 2014 (used in 13 cases) had a greater rate of retreatment (46.2% vs. 10.7%).

Aneurysm 40

Aneurysm Stent Stents ICU 40

Stroke Journal

JANUARY 30, 2025

We excluded patients who had a clear contraindication to Eptifibatide, received a stent, or if the luminal stenosis was related to reactive vasospasm and any cases with TICI 0, 1, or TICI 3 scores.Results:Our sample size was 60 (51.7% female, mean age 63.9).

Stenosis 40

Stenosis Thrombolysis Stroke Strokes 40

Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. It was stented. He wrote most of it and I (Smith) edited. Still, such dramatic changes cannot be overlooked. V2 has some features of type 2 Brugada phenocopy. This was a large OMI.

Chest Pain 116

Chest Pain STEMI Echocardiogram Stent 116

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Here we showed the efficacy and safety of PCSK9 inhibitor injection immediately prior to mechanical thrombectomy for these patients.MethodsThe subjects were stroke patients who underwent mechanical thrombectomy at Inha University Hospital from April 2019 to March 2023. vs 53.4%, p = 0.04).

Stroke 40

Stroke Strokes Stent Stents 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionTo provide our single‐institution experience and outcome data with the WEB device in 51 patients treated for ruptured and unruptured intracranial aneurysms.MethodsOcclusion rates in a cohort of 51 patients treated with WEB were collected at time of procedure and at last follow‐up between the years 2019 and 2021.

Aneurysm 40

Aneurysm Embolism Hemorrhage Document 40

Dr. Smith's ECG Blog

MAY 13, 2020

One would not expect wall motion to recover so quickly after stenting, so this is good evidence that the POCUS echo was indeed accurate. Angiogram: Severe diffuse left main disease, up to 80% at the ostial left main. Post cath ECG: Normal or near normal Peak troponin I was 15 ng/mL.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Clinical outcome was treatment‐related visual complications.ResultsA total of 60 patients treated at our tertiary center between January 2017 and November 2019 were reviewed. Imaging outcomes were aneurysm occlusion and OA patency at 1‐year, determined by Digital Subtraction Angiography (DSA) or MRA. 4 patients were lost to follow up.

Aneurysm 40

Aneurysm Outcomes Embolism Stent 40

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. the most commonly overlooked arrhythmia ( See My Comment at the bottom of the page in the May 1, 2023 — and the November 12, 2019 post , among others ). The last echocardiography 12 months ago showed HFmrEF.

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

JANUARY 16, 2020

It was opened and stented with resulting TIMI-3 (normal) flow. The stent to LCX is patent. When I didn’t — I went back to the August 9, 2019 Post that Dr. Smith references in his comments above. I have summarized the major points from Dr. Smith’s 8/9/2019 post in Figure-1. OM1 is occluded and OM2 has 60% stenosis.

Aneurysm 40

Aneurysm Heart Disease Stent Stents 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

5 ICSS‐ MRI study (International Carotid Stenting Study Magnetic Resonance Imaging Study), indicated that patients with periprocedural hemodynamic depression had decreased cerebral blood flow and increased the risk of new lesions in imaging.6 This is secondary to delayed postoperative cerebral ischemia and infarction caused by vasospasm.7

Aneurysm 40

Aneurysm Stroke Strokes Ischemia 40

Dr. Smith's ECG Blog

MAY 23, 2023

LAD and D1 were stented, but flow unfortunately could not be well restored despite efforts (they list the post intervention TIMI flow still as 0). We wrote this Editorial in the Journal of Electrocardiology in 2019. Serial tracings following stent placement confirmed the large extent of myocardial injury.

Chest Pain 98

Chest Pain STEMI Blog Stent 98

Dr. Smith's ECG Blog

JUNE 28, 2019

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. It was stented. The patient had a p rior h istory of MI + stents. Time zero What do you think? There is inferior ST elevation. Is it normal variant? Is it ischemic (OMI)? Pericarditis? Compare with an old ECG.

Chest Pain 52

Chest Pain Pericarditis Stent Stents 52

EMS 12-Lead

APRIL 14, 2022

Troponin I returned 80 ng/mL, and the Cath Lab was then reactivated where a 100% LAD occlusion was found and stented. The nearest PCI center was activated but ultimately denied by Cardiology. Chapter 22: Electrolytes, Temperature, Central Nervous System Disease, and Miscellaneous Effects. Elsevier-Saunders: Philadelphia, PA. [5]. McCance, K.

ACE Inhibitor 52

ACE Inhibitor Physiology Chest Pain Academic 52

Dr. Smith's ECG Blog

AUGUST 15, 2019

They found 100% acute mid-LAD Occlusion MI, stented with excellent angiographic result. Ongoing ischemia (by symptoms, ECG, or troponin) despite maximal medical management is an indication for emergent cath lab activation. == MY Comment by K EN G RAUER, MD ( 8/15/2019 ): == Once again, the w rong q uestion was a sked in this case.

STEMI 52

STEMI Chest Pain Risk Factors Anatomy 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain. Int J Cardiol 2019 2. -- Meyers HP, Bracey, Smith et al. J Electrocardiol 2019 6. -- Amsterdam EA, Wenger NK, Brindis RG, et al. Ischemic ST depression maximal in V1-V4 (vs.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

EMS 12-Lead

MAY 20, 2022

A mid-LAD culprit lesion was identified and stented. Cardiology felt her chest pain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e. Type II MI), however decided to pursue coronary angiogram out of an abundance of caution. References Naidu, S. American College of Cardiology.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

AUGUST 17, 2019

100% proximal LAD successfully stented. I recognized this as a STEMI immediately and I was only able to do so solely because of your blog." == Comment by K EN G RAUER, MD ( 8/18/2019 ): == Our thanks to Dr. "Cardiology agreed to take the pt to the lab but thought it would likely be negative. Defibrillated out of v fib in the cath lab.

Chest Pain 52

Chest Pain STEMI Blog Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 22, 2019

Troponin profile The patient underwent angiography and had a 90% thrombotic proximal LAD lesion that was stented. See this: Classic Evolution of Wellens' T-waves over 26 hours And a bit of further evolution here. The estimated left ventricular ejection fraction is 61 %.

Chest Pain 52

Chest Pain Ischemia STEMI Stent 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The culprit lesion was opened and stented. For more on this mirror-image opposite ST-T wave relation in leads III vs aVL — See My Comment in the March 8, 2019 and August 9, 2018 posts in Dr. Smith's ECG Blog ). The QoH now recognizes the OMI with mid confidence. Below is the post -PCI electrocardiogram.

Chest Pain 60

Chest Pain Blog Ischemia Risk Factors 60

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

It was stented. == MY Comment by K EN G RAUER, MD ( 9/27/2019 ): == As suggested by the title of this Blog post — confirmation of the diagnosis in this case was made not by ECG — but instead by chest aorta CT !

Chest Pain 52

Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

MAY 11, 2019

Here is the post stent ECG: This is probably the amount of ST elevation (zero) that this patient has at baseline. At angiogram with a rapid door to balloon time: Culprit is 100% occlusion of the LAD Mid segment. Note the beginning of Wellens' (reperfusion T-waves) in V3-V6.

Chest Pain 52

Chest Pain STEMI Stent Stents 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction. In the setting of prior stenting and reduced left ventricular ejection fraction, would pursue a heart team revascularization approach Syntax score 28.5, This alone could be due to LVH, but V4 could NOT be due to LVH.

Chest Pain 52

Chest Pain Coronary Artery Bypass Graft Pericarditis Blog 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

They were stented. We wrote this Editorial in the Journal of Electrocardiology in 2019. [link] Unbeknownst to us at the time, there was an old ECG for comparison from 3.5 years prior which I only found a day later: This is a truly normal ECG, with normal sized T-waves and normal S-waves in V2 and V3. The peak troponin was 1863 ng/L.

Chest Pain 52

Chest Pain STEMI Article Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

The lesion was successfully stented, but it was unfortunately done after a significant myocardial loss. 2019 Apr;21(5):253-258. You may see a filling defect in distal LAD, most probably due to an embolization from proximal lesion. Also note that LAD does not extensively wrap-around apex and supply inferior wall. Anatol J Cardiol.

Chest Pain 52

Chest Pain Myocardial Infarction Blog Pericarditis 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Slow TIMI 2 initially with brisk flow status post percutaneous coronary intervention with 18mm drug-eluting stent. 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. To our knowledge, the patient did well.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

JULY 11, 2019

100% proximal LAD thrombotic occlusion with TIMI 0 flow was found and stented with excellent angiographic result and TIMI 3 flow. When in doubt, record serial ECGs and watch out for signs of ischemia despite medical management. == Comment by K EN G RAUER, MD ( 7/11/2019 ): == Our thanks to Drs. Cath images: Before intervention.

Chest Pain 52

Chest Pain STEMI Blog Article 52

Dr. Smith's ECG Blog

DECEMBER 16, 2019

It was opened and stented. link] == MY Comment, by K EN G RAUER, MD ( 12/17/2019 ): == Great case about some subtleties in association with LBBB. Chest pain with New LBBB: It helps to actually measure the ST/S ratio A Fascinating Demonstration of ST/S Ratio in LBBB and Resolving LAD Ischemia The cath lab was activated.

Chest Pain 52

Chest Pain Myocardial Infarction Stent Stents 52

Dr. Smith's ECG Blog

JULY 19, 2019

Thrombectomy performed, then stent placed with improvement of TIMI 0 to TIMI 3 flow. Always keep in mind the possibility of diffuse STE (and other OMI findings) as being due to a type 3 LAD. == Comment by K EN G RAUER, MD ( 7/19/2019 ): == I was intrigued by the challenge of clinical correlation posed by the ECGs in this case.

Chest Pain 52

Chest Pain STEMI Aneurysm Pericarditis 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

I describe and illustrate in detail my approach to incorporating these criteria in My Comment at the bottom of the December 16, 2019 post in Dr. Smiths ECG Blog. There was 100% occlusion of the RCA, which was stented. Dr. Smith illustrates how to measure these parameters with magnified views in his December 21, 2015 post.

Chest Pain 52

Chest Pain STEMI Blog Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 23, 2019

They had a history of non-ischemic cardiomyopathy (EF 30%), as well as PCI with one stent. Case contributed by Brooks Walsh , an emergency physician and ECG aficionado in Connecticut (and a few comments by Smith) A middle-aged patient came to the ED complaining of palpitations, dyspnea, sweating, and chest pressure that radiated to the arms.

Tachycardia 52

Tachycardia Atrial Flutter Cardiomyopathy Atrial Fibrillation 52