2020 Ischemia Plaque 
Dr. Smith's ECG Blog
NOVEMBER 15, 2023
This suggests further severe ischemia. MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. And yet the arteries remain open.
Dr. Smith's ECG Blog
NOVEMBER 3, 2023
The baseline ECG is basically normal with no ischemia. You can see in the lead-specific analysis that she "sees" the STD in V5, V5, and II, with STE in aVR as signs of "Not OMI", because subendocardial ischemia pattern is not the same as OMI. In my opinion, I think it looks more like subendocardial ischemia.
Dr. Smith's ECG Blog
MARCH 22, 2024
The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible. Back to the assessment of ischemia: Returning to the ECG, the leads that catch my eye first are -- I, II, V4, V5, V6. Ischemia can be disguised by a wide escape rhythm, which decreases the sensitivity of ECG.
Dr. Smith's ECG Blog
NOVEMBER 9, 2023
Time 17 minutes Not much different One month earlier This is Left Bundle Branch Block (LBBB) without any sign of ischemia. Ramus: There is a large caliber branching ramus intermediate LAD is a medium caliber vessel that extends to the apex and is noted to have diffuse mild to moderate plaque in the midsegment. Post Procedure TIMI III.
DAIC
FEBRUARY 29, 2024
24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m. ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.
Dr. Smith's ECG Blog
NOVEMBER 30, 2022
To prove there is no plaque rupture, you need to do intravascular ultrasound (IVUS). An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!! One of the most common is rupture of a non-obstructive plaque, with thrombus formation and OMI that spontaneously lyses and leaves a wide open artery. It can only be seen by IVUS.
Dr. Smith's ECG Blog
DECEMBER 14, 2022
Is this Acute Ischemia? Reperfusion of OMI indicates at least partial thrombolysis of occluding thrombus, but still unstable plaque rupture, which can reocclude at any moment. No formal echo was done, and EF was normal on ventriculogram during cath, with no obvious wall motion abnormalities. More on LVH. LVH with anterior ST Elevation.
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