Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. A New ST-segment elevation myocardial infarction equivalent pattern? Academic Emergency Medicine 27(S1): S220; May 2020.

Chest Pain 83

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the ED ECG on arrival: Less STE/STD Provider's Clinical Impression: "findings concerning for myocardial infarction, likely proximal LAD or Left main." One would not expect wall motion to recover so quickly after stenting, so this is good evidence that the POCUS echo was indeed accurate. NTG drip started.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

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). Serial tracings following stent placement confirmed the large extent of myocardial injury. LCX and RCA were described as "normal" in the cath report.

Chest Pain 98

Chest Pain STEMI Blog Stents 98

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. Prospective validation of current quantitative electrocardiographic criteria for ST-elevation myocardial infarction. JAMA Cardiol 2020 5. -- Litell JM, Meyers HP, Smith SW.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

In the STEMI/NSTEMI dichotomy, NSTEMI is supposed to mean non-occlusive myocardial infarction, but this patient had transient Occlusion MI that was at risk for re-occlusion (like ‘transient STEMI’). Notice also that there is new T-wave inversion in III with upright T-wave in aVL, confirming inferior infarction.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

MARCH 19, 2023

Angiogram: Culprit for the patient's inferior ECG changes and non-ST elevation myocardial infarction is a 100% acute thrombotic occlusion of the proximal RCA. It was opened and stented. Traditionally , Occlusion MI (OMI) myocardial infarctions that are not STEMI are called NonSTEMI.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Document 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Occlusion myocardial infarction is a clinical diagnosis Written by Willy Frick (@Willyhfrick). Here is the angiogram after stent placement. The patient suffered a large infarct. St depression in lead AVL differentiates inferior st-elevation myocardial infarction from pericarditis. Circulation , 130 (25).

Myocardial Infarction 123

Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Dr. Smith's ECG Blog

JANUARY 6, 2023

Association between opioid analgesia and delays to cardiac catheterization of patients with occlusion Myocardial Infarctions. A single DES stent was placed, and the patient did well post-procedure. Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. Abstract 556.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

== MY Comment by K EN G RAUER, MD ( 9/17/2020 ): == Todays patient is a previously healthy, 60-something year-old woman who presented with chest pain that began at a reception. There was 100% occlusion of the RCA, which was stented. Her initial 12-lead ECG that was obtained by paramedics in the field is shown in Figure-1.

Chest Pain 52

Chest Pain STEMI Blog Myocardial Infarction 52

DAIC

DECEMBER 14, 2023

Doctors then treat the cause of the heart attack, either inserting a stent, removing a clot or taking other necessary action. Patients were enrolled between July 2016 and December 2020. The Impella® heart pump, an FDA-approved device, is inserted through a catheter in the groin as soon as the patient arrives at the hospital.

Cardiogenic Shock 105

Cardiogenic Shock Heart Attack Heart attacks Myocardial Infarction 105

Journal of the American Heart Association

APRIL 10, 2025

The primary outcome was the composite occurrence of stroke, myocardial infarction, and allcause death following carotid revascularization. The cohort included 14 220 patients with type 2 diabetes who underwent carotid revascularization (2669 via carotid endarterectomy and 11 551 via carotid stent insertion).

Diabetes 40

Diabetes Outcomes Myocardial Infarction Stents 40

Cardiology Update

FEBRUARY 14, 2024

In the early years of percutaneous coronary intervention (PCI), studies indicated a heightened risk of major adverse cardiac events (MACE) in patients with reduced left ventricular ejection fraction (LVEF), involving outcomes such as death, Q-wave myocardial infarction (MI), stent thrombosis, and repeat revascularization.

Myocardial Infarction 52

Myocardial Infarction Coronary Artery Disease Thrombosis Research 52

Open Heart

APRIL 15, 2022

The 2020 European Society of Cardiology (ESC) Guidelines recommend the use of prasugrel over ticagrelor in patients with non-ST-elevation ACS (NSTE-ACS) intended to receive invasive management (class IIa recommendation), however there are contradictory views regarding this recommendation.

Myocardial Infarction 52

Myocardial Infarction Thrombosis Stents Stent 52

EMS 12-Lead

APRIL 21, 2022

His father and brother both died of myocardial infarction at ages 61 and 45, respectively. Advanced multi-vessel disease was found with stents deployed to the mid-LCx (80% stenosis), D1 (90% stensosis), and the pLAD (95% stenosis). A new electrocardiographic pattern indicating inferior myocardial infarction.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This is a case written by Dan Lee (One of our fantastic Hennepin Residents, class of 2020 ) edits by Smith A 60 something-year-old man with a history of ESRD, LVH and prior CABG presented after an episode of hypotension during his hemodialysis, run followed by a syncopal episode which caused his run to be terminated early. What can we learn?

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

He was successfully treated with one drug eluting stent. High-Sensitivity Cardiac Troponin Concentrations at Presentation in Patients With ST-Segment Elevation Myocardial Infarction. 1] Wereski, R., Chapman, A. Gray, A., & & Mills, N. JAMA Cardiology , 5 (11), 1302–1304.

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Paddy Barrett

AUGUST 1, 2023

This is where careful discussion with the patient is required, and an explanation of the most recent literature suggests no reduction in future major heart events with stenting in most obstructive coronary artery disease 5. ( 2 Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. 2020 Jan 14;41(3):407-477.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Mark Erfe Outcomes of Sutureless/Rapid Deployment Valves Compared to Traditional Bioprosthetic Aortic Valves The Annals of Thoracic Surgery September 2020 J. Mark Erfe Outcomes of Sutureless/Rapid Deployment Valves Compared to Traditional Bioprosthetic Aortic Valves The Annals of Thoracic Surgery September 2020 J.

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori 1 Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion 2 Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The (..)

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Dr. Smith's ECG Blog

MARCH 14, 2025

ECG #3 is easily recognized as OMI and the AI model recommends immediate revascularization The patient in today's case received suboptimal care and suffered a substantial myocardial infarction. He eventually underwent CAG, where a circumflex occlusion was stented. Academic Emergency Medicine 27(S1): S220; May 2020.

Chest Pain 106

Chest Pain STEMI Myocardial Infarction Ischemia 106

Dr. Smith's ECG Blog

MARCH 1, 2025

He reports this was similar to how he felt when he had his heart attack 4 years prior, now s/p 4 stents. A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. He states that it feels like burning and pressure, like GERD. The history gives a subtle hint that this might be another acute OMI.)

Chest Pain 121

Chest Pain STEMI Stents Stent 121

Dr. Smith's ECG Blog

MARCH 19, 2025

Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. He had a 100% RCA occlusion which was stented.

Chest Pain 116

Chest Pain STEMI Stents Stent 116

Dr. Smith's ECG Blog

JANUARY 31, 2025

of patients with anterior myocardial infarction ( 1 ). At cath there was a 100% proximal LAD occlusion, which was opened and stented. Tall precordial T waves with depressed ST take-off: an early sign of acute myocardial infarction? There is a de Winter T- wave pattern also in lead I. I have referenced Soo 3 times.

STEMI 113

STEMI Chest Pain Myocardial Infarction Ischemia 113

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

It was opened and stented. Compared to TTE from 7/3/24: the anterior regional wall motion abnormality is new and is consistent with ischemia/infarction in the LAD territory == MY Comment , by K EN G RAUER, MD ( 11/20 /2024 ): == There are several insightful aspects of today's case. The November 10, 2020 post — for PTA.

Blog 63

Blog Chest Pain Myocardial Infarction Critical Care 63

Dr. Smith's ECG Blog

JANUARY 23, 2025

Case A 76 year old man with chronic hypertension but no history of coronary disease or myocardial infarction presented to the ED with chest pain at 2343. It was treated with a drug eluting stent. It is awaiting FDA approval (but approved for 1.5 See the Terminology and Semantics section of Willy Frick's cardiac cath guide).

Chest Pain 116

Chest Pain Ischemia STEMI Blog 116