EMS 12-Lead

APRIL 21, 2022

There is appreciable STE aVR with near-global STD that appropriately maximizes in Leads II and V5, and thus suggesting a circumstance of generic, diffusely populated, circumferential subendocardial ischemia versus occlusive coronary thrombus. [1] There is evolution from Wellens Pattern A to Pattern B, now inclusive of V6.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

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. ( Some residual ischemia in the infarct border might still be present. Both episodes are initiated by an "R-on-T" phenomenon.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Stroke Journal

JANUARY 30, 2025

This observational cohort study investigates clinical approaches and long-term outcomes of iatrogenic CeAD after endovascular interventions.Methods:We conducted a retrospective chart review to analyze patients who underwent endovascular treatments at the Mayo Clinic from 1998 to 2021. Pertinent patient factors were extracted.

Stents 40

Stents Stent Angioplasty Aneurysm 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:Tenecteplase (TNK) is becoming the preferred thrombolytic for acute brain ischemia. A six-month lead-in, six-month introductory, and one-year transition period began in April 2021 using an intentional change method. We subsequently educated constituents including nursing, pharmacy, technical and clinical staff.

Hemorrhage 40

Hemorrhage Education Nursing Ischemia 40

Ken Grauer, MD

OCTOBER 13, 2023

As a result — IF no "fixable" cause is found ( ie, ischemia/infarction — electrolyte disturbance — rate-slowing medication ) — then because of the AV block and very slow heart rate, this patient will probably need a pacemaker. There are also twice as many P waves as QRS complexes — so at the least, there is 2nd-degree AV block.

Blog 159

Blog Arrhythmia Bradycardia Download 159

Dr. Smith's ECG Blog

JANUARY 3, 2022

2] Here there is no posterior ST elevation, but the anterior ST depression is also less—so it is dynamic, confirming acute ischemia. The absence of STE in V7-V9 is often due to resolution of ischemia, as seen by resolution of ST depression in V7-V9. non-occlusive ischemia) JAHA 2021 3. -- Meyers HP, Bracey A, Lee D, et al.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

JULY 14, 2023

My interpretation was: RBBB with hyperacute T-waves in V4-V6 that are all but diagnostic of LAD occlusion vs. post ROSC ischemia. The patient had ROSC and maintained it. A 12-lead ECG was obtained: What do you think? Smith's ECG Blog — Interpretation of a post-resuscitation ECG can be extremely challenging.

Cardiac Arrest 98

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Dr. Smith's ECG Blog

AUGUST 17, 2022

ACUTE MI (I allowed Acute MI to be in the report because I knew there would be an elevated troponin from ischemia, which is the definition of acute MI -- but in this case it would most likely be a Type 2 MI from tachycardia) There is also LA-RA lead reversal. The November 27, 2021 post ( LA-RA reversal ).

Atrial Fibrillation 52

Atrial Fibrillation Ischemia AFIB Tachycardia 52

Stroke Journal

JANUARY 30, 2025

We performed this analysis to identify the prevalence of atrial fibrillation and associated outcomes in symptomatic internal carotid artery stenosis patients undergoing CAS or CEA.Methods:We analyzed the data from the National inpatient sample (NIS) between January 2016 to December 2021. versus 18.8% for CAS or CEA, respectively, p=0.50].

Atrial Fibrillation 40

Atrial Fibrillation Stent Stents Outcomes 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. There is 1 mm of ST segment elevation in lead aVR — which in the context of ST segment flattening in most other leads, suggests that there may be a component of subendocardial ischemia from underlying coronary disease. Detailed coronary artery evaluation not performed. Downstream vasospasm?

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Stroke Journal

FEBRUARY 1, 2024

Objective:To assess whether diffusion restriction (DR) of the retina and optic nerve (ON) can be accurately and reliably identified on standard stroke protocol brain magnetic resonance diffusion-weighted imaging (DWI-MRI) in patients presenting with acute non-arteritic central retinal artery occlusion (CRAO).Background:Retinal

Ischemia 40

Ischemia Academic Education Strokes 40

Dr. Smith's ECG Blog

APRIL 22, 2022

Am J Med 2021 5. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines JACC 2021 8. Was this objective evidence of inducible ischemia accompanied by chest pain?

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

Stroke Journal

JANUARY 30, 2025

Background:COVID-19, primarily a respiratory illness caused by SARS-CoV-2, is associated with vascular complications like ischemia due to endothelial injury, hypercoagulability, and inflammation. A subgroup analysis was conducted for patients during the vaccination period (April 14, 2021, to March 1, 2022).

COVID-19 40

COVID-19 Strokes Stroke Outcomes 40

Circulation

NOVEMBER 11, 2024

The outcome measure was peri-procedural complications defined as a composite of perioperative death, major bleeding, contrast nephropathy, myocardial infarction, ischemic stroke, and major amputation. Notable comorbidities included diabetes mellitus at 60.6% and dialysis at 29.9%, respectively. of the participants.

Myocardial Infarction 40

Myocardial Infarction Coronary Artery Disease Ischemia Diabetes 40

Dr. Smith's ECG Blog

OCTOBER 18, 2023

A majority (62.5%) of those presenting with ‘normal’ ECGs had the cath lab activated without any ECG being labeled ‘STEMI’ by automated interpretation – based on signs of Occlusion MI including ECG changes, regional wall motion abnormality on bedside ultrasound, or refractory ischemia. 2021 ; 46 : 23 - 26 4. Acad Emerg Med.

Chest Pain 119

Chest Pain STEMI Electrocardiogram Ischemia 119

Dr. Smith's ECG Blog

JANUARY 6, 2024

In the days before I learned to look for OMI, back when I was counting ST elevation boxes, I used to save ischemia for last.) I interpret tracings systematically in "real time" ( including my assessment for acute ischemia ). The November 27, 2021 post ( LA-RA reversal ). The rate is near 80, normal.

Blog 111

Blog Ischemia Tachycardia STEMI 111

Stroke Journal

JANUARY 30, 2025

The right TRA was performed as a first-line approach from 2019 to 2021, with the left TRA being used thereafter. Patients who underwent proximal balloon-protected CAS were excluded. We analyzed patient characteristics, clinical outcomes, and the presence of lesions on postprocedural diffusion-weighted imaging (DWI lesions).Results:A

Stent 40

Stent Stents Aortic Interventional Cardiology 40

Stroke Journal

JANUARY 30, 2025

Remote ischemic conditioning (RIC) with transient ischemia and reperfusion applied to the arm has been shown to accelerate hematoma resolution in both animal and clinical studies. Results:Between Apr 22, 2021, and Oct 30, 2023, 458 patients were randomly assigned, with 229 in each group. 13.0), and the median hematoma volume was 12.6

Hemorrhage 40

Hemorrhage Outcomes Ischemia Strokes 40

Stroke Journal

FEBRUARY 1, 2024

Stroke, Volume 55, Issue Suppl_1 , Page A48-A48, February 1, 2024. Objective:To compare the 1-month stroke, myocardial infarction (MI), and/or death rates among symptomatic patients undergoing either CAS or CEA according to the timing of the procedure in Carotid Revascularization Endarterectomy versus Stenting Trial (CREST).Methods:We

Stent 40

Stent Stents Stenosis Myocardial Infarction 40

DAIC

JANUARY 3, 2024

Traditional methods of non-invasive ischemia testing (stress EKG , stress echo, SPECT , PET , direct-to-cath) can result in false negatives 20-30 percent of the time, which can lead to undetected disease, and false positives over 50 percent of the time, which can lead to unnecessary invasive procedures. 2021 ACC/AHA Chest Pain Guidelines.

Coronary Artery Disease 59

Coronary Artery Disease Chest Pain Plaque Technology 59

EMS 12-Lead

MAY 8, 2022

This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] Chapter 6: Introduction to Myocardial Ischemia and Infarction. 2] But there is also Sinus Tachycardia!

ACE Inhibitor 52

ACE Inhibitor Ischemia STEMI Physiology 52

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And superimposed subendocardial ischemia pattern, of course. A number of potentially severe pulmonary complications t hat convey higher morbidity and mortality are commonly seen in patients with CTD ( Taha and Feteih — NIH, Skills in Rheumatology, 2021 ). She was otherwise very stable during this rhythm.

Atrial Flutter 126

Atrial Flutter Blog Aortic Aortic valve 126

Dr. Smith's ECG Blog

MARCH 22, 2022

There is no ischemia, certainly no concern at all for OMI. These ER patients did not have ischemia — and the variation in ST elevation was not related to either heart rate or QRS amplitudes ( Variation in ST-Segment Elevation in Early Repolarization: Electrocardiography 40:10,2007 ).

Blog 52

Blog Chest Pain Ischemia Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). Figure-3: Diagnostic considerations for a patient who presents in AV block ( adapted from Mangi et al — StatPearls, 2021 ). Usually the medical history will provide clues to the cause.

Tachycardia 107

Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 107

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

See Costagliola et al — Ann Clin Transl Neurol 8(7): 1557-1568, 2021 — for more on the complex "Brain-Heart Interaction" in Epilepsy ). mEq/L for K+ and 1.76 Over the years, I have found recall of a short LIST of Causes of QT Prolongation to be of invaluable assistance.

Tachycardia 113

Tachycardia Blog Sudden Cardiac Death Arrhythmia 113

EMS 12-Lead

APRIL 8, 2022

When “spot diagnosing” precordial ST-depression I instinctively evaluate aVR for any corresponding ST-elevation to see if an emerging pattern of broad subendocardial ischemia can be appreciated, in which the ST-depression should be otherwise global and demonstrably maximal in Leads II and V5. ST-elevation, etc.) is present. 5] Meyers, H.

Myocardial Infarction 52

Myocardial Infarction Coronary Angiogram STEMI Ischemia 52

Dr. Smith's ECG Blog

MAY 5, 2023

Common explanations for unusual rhythms such as this one include: i ) Hyperkalemia ( or other severe electrolyte disorder ); ii ) Recent infarction/ischemia; iii ) Sleep apnea; iv ) Severe hypothyroidism; v ) Acute neurologic catastrophe (ie, stroke, bleed, trauma, tumor ); vi ) Some other toxicity. Narcan was not given at the scene.

Bradycardia 52

Bradycardia Cardiac Arrest Arrhythmia Pacemaker 52

EMS 12-Lead

APRIL 28, 2022

In most cases, rather, the culprit is gross ischemia due to myocardial infarction, cardiomyopathy, or advanced coronary artery disease. Unfortunately, today’s case is lacking any such diagnostics, thus I cannot say with certainty that the QT interval is, or is not, culpable in arrhythmogenesis. [1] Wolters-Kluwer: Philadelphia, PA. [2]

Tachycardia 52

Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). 2021 Dec 7;10(23):e022866. Epub 2021 Nov 15. J Am Heart Assoc. doi: 10.1161/JAHA.121.022866. 121.022866.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Ken Grauer, MD

OCTOBER 27, 2023

This suggests ischemia of uncertain duration. The October 25, 2021 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) reviews my approach to another case of a Dual-Level Wenckebach block. There is deep, symmetric T wave inversion with a prolonged QTc interval in anterior leads V1,V2,V3.

Blog 101

Blog Pacemaker Bradycardia Arrhythmia 101

Dr. Smith's ECG Blog

DECEMBER 18, 2022

If you still have not read it, I strongly recommend that you read the following article on the diagnosis of "posterior" MI: Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia), by Meyers HP et al. 2021 Dec 7;10(23):e022866.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

DAIC

JANUARY 23, 2024

mg reduced the risk of cardiovascular death, MI or heart attack, ischemic stroke, or ischemia-driven coronary revascularization by 31% compared with placebo.34 2021 Apr 20;77(15):1958-1959]. This in turn leads to an overall reduction in IL-6 production and CRP concentration.12 12 Colchicine, 0.5 34 Colchicine, 0.5 J Am Coll Cardiol.

Cardiovascular Disease 111

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease 111

EMS 12-Lead

JUNE 1, 2022

Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. Lead V2 shows RR’ QRS configuration, and although ST depression is otherwise expected here, the discordance is a bit excessive. 6] Tabrizi, F.,

Heart Failure 52

Heart Failure Myocardial Infarction Bradycardia Chest Pain 52

Dr. Smith's ECG Blog

MAY 8, 2023

Annals of Emergency Medicine 2021. EKG shown here: LAFB with no clear signs of OMI or ischemia. Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria. In which we compared ventricular paced OMIs with Non-OMIs and MI-ruled out patients.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

MAY 5, 2022

These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia/infarction/cardiac arrest — and Hyperkalemia. The November 27, 2021 post ( LA-RA reversal ). PEARL # 5: A number of conditions other than Brugada Syndrome may temporarily produce a Brugada-1 ECG pattern.

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Figure-2: Classification of Underlying Diagnoses in Patients with MINOCA ( Adapted from Table-1 in Sykes et al: Interventional Cardiology Review: 16:e10, 2021 ).

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Circulation

DECEMBER 28, 2023

The outcome was arterial thromboembolism (ischemic stroke, embolism of extremity, or transient cerebral ischemia). Female sex was not considered a risk factor in any risk group.

Atrial Fibrillation 58

Atrial Fibrillation Heart Failure Risk Factors Diabetes 58