2022, Plaque and Ultrasound - 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

Bedside cardiac ultrasound with no obvious wall motion abnormalities. Thus, it has recently become generally accepted that most plaque ruptures resulting in myocardial infarction occur in plaques that narrow the lumen diameter by 40% of the arterial cross section may be involved by plaque. He was started on nitro gtt.

Ischemia

Ischemia Plaque Stenosis Myocardial Infarction

How To Reverse Coronary Artery Disease With Lifestyle Measures

Dr. Paddy Barrett

DECEMBER 19, 2023

You cannot eliminate the plaque entirely, but multiple clinical trials have shown plaque regression using high-intensity cholesterol-lowering treatments, which I have discussed previously. All of these parameters are important and need to be considered when evaluating plaque regression. REVERSAL Investigators.

Coronary Artery Disease

Coronary Artery Disease Plaque Exercise Heart Attack

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

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

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Abstract TP226: Analysis of the Association Between Lipoprotein(a) Levels and Carotid Plaque and Coronary Artery Calcium Using Health Checkup Data

Stroke Journal

FEBRUARY 1, 2024

Carotid ultrasound results were divided into two groups based on the presence or absence of plaque. Carotid plaque was observed in 1140 (43.5%) subjects and CACS>0 in 1172 (44.7%) subjects. Lp(a) levels were categorized into two groups: below 50 mg/dl and 50 mg/dl or higher. 1692 (64.6%) were male. Mean age was 57 years.

Plaque

Plaque Coronary Artery Disease Ultrasound Atherosclerosis

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

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

Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain. Angiography : --Culprit for the patient's unstable angina/Wellen syndrome is a ruptured plaque in the mid LAD. --As Course : Aspirin 325mg, chemistry, CBC, troponin panel all ordered.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

Abstract TP288: Prevalence and Gender Differences in Carotid Atherosclerosis Among Adults: Evidence from a Cohort Study in China

Stroke Journal

JANUARY 30, 2025

This study aimed to determine the current prevalence of CAS and examine the associated gender differences in adults.Methods:From September 2021 to June 2022, we established a prospective cohort to study CAS and cardiovascular disease across 25 project sites in Henan, China, utilizing a multistage whole-population sampling method.

Atherosclerosis

Atherosclerosis Plaque Stenosis Cardiovascular Disease

"The dye don't lie".except when it does. Angiogram Negative, or is it?

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again. It is worthwhile remembering that the majority of plaques which rupture are non-obstructive before they ulcerate and thrombose. Most plaque is outside the lumen!!

Plaque

Plaque Stents Stent Chest Pain

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

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

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

OCTOBER 10, 2022

As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow). Now another, with ultrasound. What is the Diagnosis?

Cardiac Arrest

Cardiac Arrest Chest Pain Embolism Pulmonary

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. == MY Comment, by K EN G RAUER, MD ( 11/4 /2022 ): == Our thanks to Drs.

Ischemia

Ischemia STEMI Stenosis Chest Pain

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

Acute chest pain and an abnormal ECG. Do precordial leads show benign T-wave inversion or ischemia?

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

The operator performed intravascular ultrasound and visualized acute plaque rupture with thrombus formation and placed a stent. When in need of a "Refresher" on what BTWI may look like — I suggest periodically checking out Dr. Meyers' March 22, 2022 post — in which he shows a series of cases illustrating BTWI in "all of its flavors".

Chest Pain

Chest Pain Ischemia Stents Stent

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

How To Reverse Coronary Artery Disease With Lifestyle Measures

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

Abstract TP226: Analysis of the Association Between Lipoprotein(a) Levels and Carotid Plaque and Coronary Artery Calcium Using Health Checkup Data

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

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

Abstract TP288: Prevalence and Gender Differences in Carotid Atherosclerosis Among Adults: Evidence from a Cohort Study in China

"The dye don't lie".except when it does. Angiogram Negative, or is it?

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

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

A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Noisy, low amplitude ECG in a patient with chest pain

Acute chest pain and an abnormal ECG. Do precordial leads show benign T-wave inversion or ischemia?

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