2020, Plaque and Ultrasound - Cardiovascular Update

Suboptimal Control of Small Dense Low‐Density Lipoprotein Cholesterol Is Associated With Coronary Plaque Progression: An Intravascular Ultrasound Study

Journal of the American Heart Association

FEBRUARY 26, 2025

BackgroundPlaque progression (PP) is critical between subclinical atherosclerosis and plaque rupture. Journal of the American Heart Association, Ahead of Print. Small dense lowdensity lipoprotein cholesterol (sdLDLC) is considered as the most atherogenic lipoprotein.

Ultrasound

Ultrasound Plaque Cholesterol Coronary Artery Disease

Dyslipidemia in American Indian Adolescents and Young Adults: Strong Heart Family Study

Journal of the American Heart Association

MARCH 6, 2024

We used carotid ultrasounds to detect plaque at baseline and follow‐up in 2006 to 2009 (median follow‐up=5.5 We identified incident CVD events through 2020 with a median follow‐up of 18.5 had incident plaque (109/1104 plaque‐free participants with baseline and follow‐up ultrasounds), 11.0%

Plaque

Plaque Cholesterol Ultrasound Education

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Circulation

NOVEMBER 11, 2024

The incidence of no-reflow was higher in patients with attenuated plaque ≥5 mm in length as evaluated by intravascular ultrasound (IVUS).Objective:The The incidence of no-reflow was higher in patients with attenuated plaque ≥5 mm in length as evaluated by intravascular ultrasound (IVUS).Objective:The vs. 41.2%, p=0.043).Conclusion:In

Ultrasound

Ultrasound Plaque Blood Pressure Myocardial Infarction

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

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. Thus, intracoronary imaging modalities are crucial in this setting. From Gue at al.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction. It is not rare.

Plaque

Plaque Angina Blog Stents

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

If the arrest was caused by acute MI due to plaque rupture, then the diagnosis is MINOCA. Here is my comment on MINOCA: "Non-obstructive coronary disease" does not necessarily imply "no plaque rupture with thrombus." They often cannot even be recognized as culprits, as fissured or ulcerated plaque.

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

EKG from triage: Here is his previous ECG: Normal ST Elevation Resident's interpretation: Reperfusion pattern/Wellens' with biphasic T waves in V2 and V3, and in comparison to an EKG in 2020 this is new. Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

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.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

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

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!!

Plaque

Plaque Chest Pain Thrombosis Stenosis

A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.

Dr. Smith's ECG Blog

APRIL 12, 2023

On arrival, lung ultrasound confirmed pulmonary edema (B lines). Mild Plaque no angiographically significant obstructive coronary artery disease. There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD. This is proximal LAD Occlusion until proven otherwise.

Echocardiogram

Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease

30 yo woman with trapezius pain. HEART Pathway = 0. Computer "Normal" ECG. Reality: ECG is Diagnostic of LAD Occlusion.

Dr. Smith's ECG Blog

OCTOBER 23, 2022

To, me these look like anterior wall motion abnormality, but I showed them to one of our ultrasound fellows who is very interested in this. She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. She said: This is a tough one.

STEMI

STEMI Chest Pain Hospital Risk Factors

Noisy, low amplitude ECG in a patient with chest pain

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. As an aside, the LCx OMI is a type 2 event, since it is due to supply-demand mismatch from thrombus, and not due to atherosclerotic plaque rupture or erosion).

Chest Pain

Chest Pain Blog Arrhythmia Critical Care

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. Beware a negative Bedside ultrasound. She died before she could get a heart transplant. They just could not believe that a young woman could have an OMI. RBBB, LAFB, and STE in I, aVL, V2 and V3.

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

Chest pain and this ECG. Angiogram totally normal. Is this myocarditis?

Dr. Smith's ECG Blog

APRIL 13, 2025

Provocative testing is very helpful for this Coronary Thrombus with lysis (one must do optical coherence tomography or at least intravascular ultrasound to find thes non-obstructive plaques that ruptured. These plaques will often not be recognized as "culprits", because no fissuring or ulcertaion is seen. Embolism with lysis.

Chest Pain

Chest Pain Embolism STEMI Plaque

Suboptimal Control of Small Dense Low‐Density Lipoprotein Cholesterol Is Associated With Coronary Plaque Progression: An Intravascular Ultrasound Study

Dyslipidemia in American Indian Adolescents and Young Adults: Strong Heart Family Study

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Webinars

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

Concerning EKG with a Non-obstructive angiogram. What happened?

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

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

A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.

30 yo woman with trapezius pain. HEART Pathway = 0. Computer "Normal" ECG. Reality: ECG is Diagnostic of LAD Occlusion.

Noisy, low amplitude ECG in a patient with chest pain

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Chest pain and this ECG. Angiogram totally normal. Is this myocarditis?

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