Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Paddy Barrett

AUGUST 1, 2023

A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. CT Coronary Artery Calcium Score Scan CT Coronary Artery Calcium Score CT Coronary Angiogram As you can see from the above images, the CTCA provides far more anatomical detail.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Smith's ECG Blog

MARCH 9, 2025

It is not clear by her note what she meant by this (whether or not she recognized this EKG as diagnostic of transmural ischemia, and if so, of what territory) but emergent reperfusion therapy was not pursued. Subendocardial ischemia does not localize. At 1022, a troponin I (ref range <0.034 ng/mL) resulted at 4.437 ng/mL.

Ischemia 87

Ischemia Blog STEMI Coronary Angiogram 87

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 6, 2025

That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. CT coronary angiogram showed a hypoplastic RCA and dominant LCx. References: [1] 2022 ESC Guidelines for Ventricular Arrhythmias : Key Points - American College of Cardiology. 2022, September 2) [2] Ward, R. Van Zyl, M., &

Tachycardia 72

Tachycardia Arrhythmia Atrial Flutter Ablation 72