2022, Exercise and Ischemia - Cardiovascular Update

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

This confirms that the pain was ischemia and is now resovled. Review of the 2 ECGs in today's case is insightful ( Figure-1 ): The initial ECG shows sinus rhythm, LAHB and meets Peguero Criteria for LVH ( See My Comment in the August 15, 2022 post of Dr. Smith's ECG Blog for more on LVH criteria ).

Ischemia

Ischemia Plaque Stenosis Myocardial Infarction

Anterior OMI. What does the angiogram show?

Dr. Smith's ECG Blog

AUGUST 2, 2024

In this patient's case, the RV ischemia manifested as dramatic anterior hyperacute T waves. This degree of STE is a bit atypical for LAD ischemia. Remember that the RV is the most anterior chamber. Here is a transverse image of a CT showing this. A few clues that might have suggested this are: There is marked STE in V1.

STEMI

STEMI Ischemia Blog Chest Pain

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This usually represents posterior OMI, but in tachycardia and especially after cardiac arrest, this could simply be demand ischemia, residual subendocardial ischemia due to the low flow state of the cardiac arrest. This rules out subendocardial ischemia and is diagnostic of posterior OMI. The April 8, 2022 post by Drs.

Cardiac Arrest

Cardiac Arrest STEMI Ischemia SCAD

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

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Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

Dr. Smith's ECG Blog

APRIL 22, 2022

American Journal of Emergency Medicine 2022 4. Available from: [link] == MY Comment by K EN G RAUER, MD ( 4/22/2022 ): == It’s always difficult to try to “reconstruct events” when one wasn’t there. Was this objective evidence of inducible ischemia accompanied by chest pain? Bracey A, Meyers HP, Smith SW. Am J Med 2021 5.

Chest Pain

Chest Pain Ischemia Myocardial Infarction 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. ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

A man in his 40s with epigastric pain and ST Elevation

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Learning Points: Ectopic atrial rhythm can produce atrial repolarization findings that can be confused for acute ischemia, STEMI, or OMI. If you can safely and easily increase the patient's heart rate, you can convert the patient to sinus and repeat the ECG to see if the atrial repolarization wave was the cause of the concern for ischemia.

Blog

Blog Bradycardia Exercise Ischemia

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

Dr. Smith's ECG Blog

MARCH 15, 2023

Whereas at low to moderate degrees of exercise, the risk of developing AFib in younger athletic individuals is reduced — there appears to be a “threshold” for exercise intensity with longterm endurance training, beyond which the risk of developing AFib paradoxically increases! 25, 2022 ).

Atrial Fibrillation

Atrial Fibrillation AFIB Arrhythmia Exercise

What is the infarct artery? What does the post PCI ECG show? What does the convalescent ECG show?

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. He called 911. Here is the prehospital ECG. What do you think?

Aneurysm

Aneurysm Chest Pain Cardiogenic Shock Blog

Patients Undergo First Doses of New Cardiac PET tracer

DAIC

MARCH 3, 2025

Additionally, it offers clinicians the flexibility to perform exercise stress testingsomething not feasible with any previously available cardiac PET tracer. CAD is the most common form of heart disease and remains the leading cause of death for men and women in the US, with 371,506 deaths reported in 2022 [1].

Coronary Artery Disease

Coronary Artery Disease Ischemia Exercise Hospital

A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And superimposed subendocardial ischemia pattern, of course. Before continuing flecainide, he had me get on a treadmill at full dose and at full exercise (18 minutes) and measured the QRS to be certain that the QRS did not lengthen at all. She was otherwise very stable during this rhythm. Coincidence?).

Atrial Flutter

Atrial Flutter Blog Aortic Aortic valve

Brugada Syndrome: Diagnosis and Risk Stratification

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. 2022 Mar;8(3):386-405. Opinion is divided on the need for electrophysiology study. mV or R/q ≥ 0.75.

Sudden Cardiac Death

Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia

The Advantages Of A CT Coronary Angiogram

Dr. Paddy Barrett

AUGUST 1, 2023

This approach also reduces death from heart disease and heart attacks by 41% compared to conventional approaches such as exercise stress testing 2. 2022 Sep 16;101(37):e30583. 5 ISCHEMIA Research Group. The use of CTCA is often the only test that is required, therefore, avoiding further invasive testing. Medicine (Baltimore).

Coronary Angiogram

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain

Electrical instability in a healthy 50 year old. How to manage?

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

Previously healthy, taking no medication and exercising regularly. No anginal symptoms asymptomatic during physical exercise. 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.

Tachycardia

Tachycardia Arrhythmia Ablation Atrial Flutter

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Anterior OMI. What does the angiogram show?

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Webinars

Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

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

A man in his 40s with epigastric pain and ST Elevation

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

What is the infarct artery? What does the post PCI ECG show? What does the convalescent ECG show?

Patients Undergo First Doses of New Cardiac PET tracer

A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Brugada Syndrome: Diagnosis and Risk Stratification

The Advantages Of A CT Coronary Angiogram

Electrical instability in a healthy 50 year old. How to manage?

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