Dr. Smith's ECG Blog

APRIL 18, 2024

5] Back to the case The patient had serial ECGs over the next hour with no significant change: The first troponin came back at 1,400 ng/L (normal <26 in males and <16 in females), confirming MI – and the patient’s refractory ischemia indicated this was an Occlusion MI. Circulation 2014 2. Clin Cardiol 2022 4. Lupu et al.

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4142098-A4142098, November 12, 2024. The anti-angiogenic impact of neutrophil elastase clouded the understanding of the role of neutrophils in promoting neovascularization (NV) and fibrinolysis in patients with chronic limb-threatening ischemia (CLTI). 2022 May;16(5):496-510.

Document 40

Document Circulation Ischemia Hemorrhage 40

Dr. Smith's ECG Blog

AUGUST 19, 2023

But ECGs interpretation is often conflated with clinical assessment, so if patients don’t present with chest pain the ischemic changes are not seen or are attributed to something other than ischemia. Circulation 2007 2. Instead, ECGs need to be interpreted in isolation and then applied to the patient. Khan et al.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The pain will resolve and you will think the ischemia is gone when it is only hidden ! Circulation, 104(6), 636–641. African Flag Sign provided by Dr. McLaren — with additional detailed discussion of this entity in My Comment at the bottom of the page in the May 11, 2022 post in Dr. Smith's ECG Blog ). Shmueli, H., Matetzky, S.,

Chest Pain 130

Chest Pain Myocardial Infarction Blog Stents 130

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Angiography usually reveals an absence of collateral circulation to the infarct zone. It commonly occurs in the setting of a first myocardial infarction (MI) in the background of delayed or absent reperfusion therapy. I thought the presentation of today's case makes it worthwhile to review the data regarding this issue.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. Circulation [Internet] 2017;135(16):1481–9. Circulation. 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.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. S. Venkatesan MD

SEPTEMBER 23, 2024

So, we desperately required to break this inappropriate menace with evidence base like COURAGE, ISCHEMIA, BARI-2D, These studies tried to apply some breaks, but the force was weak and couldn’t abolish a pseudo-academic vice. In the process, the abuse prevailed over the use, causing considerable damage. Come September 2024. Reference 1.

Angina 52

Angina Academic Stenosis Article 52

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. S. Venkatesan MD

MARCH 19, 2024

Most IVF pregnancies seem to need it for some unknown reason) Risk of VTE Recurrent pregnancy loss(Placental micro-circulation clogging) SLE/APLA syndrome /Scleroderma VTE related PAH Mitral valve disease with AF. 2022 update on LMWH : More trouble for LMWH in pregnancy. 2022 Dec 30;101(52):e32550.) What does it imply ?

Heart Valves 52

Heart Valves Blood Clot Heart Disease Bicuspid/Mitral 52

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. 2022 Mar-Apr;71:44-46.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Smith's ECG Blog

DECEMBER 5, 2022

Incredibly , this case was just published in Circulation on January 22, 2018 (thanks to Brooks Walsh for finding this!) link] Circulation. Originally published January 22, 2018 Here is a case from Circulation year 2000 that was misdiagnosed as due to pancreatitis. Journal of Electrocardiology. 2012;45(1):15-17. 2010.12.162.

Article 52

Article Chest Pain Circulation Electrocardiogram 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

J Electrocardiol [Internet] 2022;Available from: [link] Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%) V Fib Cardiac arrest Prolonged QTC NSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different) Moderate single-vessel CAD. Circulation [Internet] 2017;135(16):1481–9. Circulation.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Of course this depends on many factors: 1) duration of occlusion, 2) whether full or near occlusion with zero flow or some flow -- the flow in the artery is the critical factor, measured by "TIMI" flow, 3) presence of collateral circulation and others. He walks a few blocks to the store and these symptoms will become worse.

Chest Pain 52

Chest Pain Coronary Artery Bypass Graft Pericarditis Blog 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). In this case, the vessel supplied a portion of the posterior LV circulation. J Am Heart Assoc. 2021 Dec 7;10(23):e022866. doi: 10.1161/JAHA.121.022866. 121.022866.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 15, 2023

These include: i ) Use of rate-slowing medication ( ie, ß-blockers, digoxin, verapamil/diltiazem, etc. ) ; ii ) Acute or recent infarction or ischemia; iii ) Hypothyroidism; iv ) Neurologic injury; v ) Electrolyte disturbance; and , vi ) Sleep apnea. 25, 2022 ).

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. This was interpreted by the treating clinicians as not showing any evidence of ischemia. The above said — it may prove insightful to take another look at the Wellens' Syndrome case instantly recognized by Dr. Smith in the August 12, 2022 post in Dr. Smith’s ECG Blog.

Chest Pain 118

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

DAIC

JANUARY 23, 2024

Inflammation driven by signaling cytokines, circulating immune cells, adhesion molecules, and oxidized low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic plaque development, plaque progression, and eventual rupture.14,15 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. Circulation.

Cardiovascular Disease 111

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease 111

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

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4135092-A4135092, November 12, 2024. Background:Prolonged operative times in surgical procedures have been significantly associated with an increased risk of complications. 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. S. Venkatesan MD

FEBRUARY 20, 2024

The simple reason could be we can address the ischemia a potential arrhythmic target by some form of revascularization in IDCM. Circulation. 2022 Feb 8;145(6):427-436. The second reason is, NDCM is a progressive primary muscle disease. Still, our understanding is largely incomplete. CRT -P vs CRT-D Samy M, Hamdy RM.

Defibrillator 52

Defibrillator Heart Failure Sudden Cardiac Death Cardiomyopathy 52

Dr. Smith's ECG Blog

JULY 22, 2023

Circulation, 117, 1890–1893. [3]: These include ( among others ) — acute febrile illness — variations in autonomic tone ( as may occur with syncope ) — hypothermia — ischemia or infarction — cardiac arrest — and electrolyte disorders ( especially hyperkalemia — but also hypokalemia/hyponatremia ). Heart Rhythm, 13(7): 1515-1520. [2]:

Chest Pain 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

DAIC

FEBRUARY 7, 2024

Joundi’ s award-winning presentation, Abstract 67, “Risk and Time-Course of Post-Stroke Dementia: A Population-Wide Cohort Study, 2002-2022,” will be presented the morning of Feb. Oriana Sanchez, M.D. , the winner of the Robert G. The Siekert New Investigator Award in Stroke recognizes Robert G. Siekert, M.D.,

Stroke 105

Stroke Strokes Research Health Disparities 105

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Outcomes included complications, NIHSS at discharge, final modified TICI (thrombolysis in cerebral ischemia) scores including the first‐pass effect (FPE, defined as mTICI 2c/3 after first pass), modified‐FPE (defined as, mTICI 2b‐3 after first pass), symptomatic intracranial hemorrhage (SITS‐MOST definition), and death at discharge.

Thrombolysis 40

Thrombolysis Ischemia Hemorrhage Strokes 40

Dr. Smith's ECG Blog

MARCH 25, 2025

There is low voltage in the precordium which always makes reading ischemia harder. In ACS, chest pain is the warning sign of ongoing ischemia. Smith : As Willy says, and as we've said many times before, morphine will resolve pain without resolving ischemia. ECG 1 What do you think? To me, this ECG is not diagnostic.

Chest Pain 63

Chest Pain Ischemia Plaque Stents 63

Dr. Smith's ECG Blog

MARCH 3, 2025

The patient was started on heparin for possible NSTEMI vs demand ischemia. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.) The EKGs from the ED presentation were felt by cardiology to represent "subendocardial ischemia." Smith : these ECGs do NOT show subendocardial ischemia.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Denying patients the potential benefit of revascularization just because their symptoms have lasted a certain amount of time shows poor understanding of the pathophysiology of myocardial ischemia. There were no other causes of dyspnea apparent and thus we can assume that myocardial ischemia started 6 days prior. Cardiology , 114.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. References: [1] 2022 ESC Guidelines for Ventricular Arrhythmias : Key Points - American College of Cardiology. 2022, September 2) [2] Ward, R. You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion.

Tachycardia 72

Tachycardia Arrhythmia Ablation Atrial Flutter 72

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Circulation Research , 114 (12), 18521866. Circulation , 92 (3), 657671. Circulation , 125 (3), 491496.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75