Frontiers in Cardiovascular Medicine

MARCH 5, 2024

Methods We conducted a retrospective analysis of 121 prenatally diagnosed patients with TGA at our hospital between January 2012 and September 2022. This analysis included prenatal ultrasound, prenatal screening, clinical management and follow-up procedures.

Ultrasound 49

Ultrasound Outcomes Hospital 49

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Bedside cardiac ultrasound with no obvious wall motion abnormalities. 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 ). He was started on nitro gtt.

Ischemia 116

Ischemia Plaque Stenosis Myocardial Infarction 116

Dr. Smith's ECG Blog

JUNE 28, 2023

He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded. The bedside ultrasound (video not available) reportedly showed only a slightly reduced LV function. The patient was given 6mg, then 12 mg, of adenosine, without a change in the rhythm. Here is the ECG: What do you think?

Tachycardia 92

Tachycardia Ultrasound Heart Disease Atrial Fibrillation 92

Dr. S. Venkatesan MD

OCTOBER 11, 2024

Green: Micra leadless pacemaker; blue: WiSE-CRT system LV endocardial electrode; and red: WiSE-CRT system subcutaneous battery and ultrasound generator. Leadless Ultrasound-Based Cardiac Resynchronization System in Heart Failure. 2022 Jan;19(1):22-29. A patient chest X-ray showing both Micra and WiSE-CRT systems. Reference 1.

Heart Failure 59

Heart Failure Anatomy Ultrasound Technology 59

Dr. Smith's ECG Blog

APRIL 22, 2024

Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain. Despite description of Wellens’ Syndrome over 40 years ago — this syndrome remains misunderstood by all-to-many clinicians ( See My Comment at the bottom of the page in the August 12, 2022 post in Dr. Smith’s ECG Blog ).

Chest Pain 119

Chest Pain Myocardial Infarction Anatomy Angina 119

Circulation

NOVEMBER 11, 2024

Background:Since January 2022, our emergency medical center has operated a prehospital extracorporeal cardiopulmonary resuscitation (ECPR) system. Cannulation is performed in a mobile ICU under mechanical CPR, with ultrasound-guided cannulation as the first choice. The ECPR team is dispatched for suspected CPA cases.

Ultrasound 40

Ultrasound ICU Outcomes Circulation 40

Stroke Journal

FEBRUARY 1, 2024

Carotid ultrasound results were divided into two groups based on the presence or absence of plaque. Lp(a) levels were categorized into two groups: below 50 mg/dl and 50 mg/dl or higher. Coronary artery calcium score CT results were analyzed in two groups: CACS=0 and CACS>0.Results:A Results:A total of 2620 subjects were enrolled.

Plaque 40

Plaque Coronary Artery Disease Ultrasound Atherosclerosis 40

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 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionIntroduction & Objectives: Transcranial Doppler (TCD) ultrasound provides rapid, noninvasive, real‐time measures of cerebrovascular function. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023.

Stroke 40

Stroke Strokes Ultrasound Embolism 40

Journal of Cardiovascular Electrophysiology

NOVEMBER 17, 2023

Methods Using endoscopy, endoscopic ultrasound, and electrogastrography before and after PVI, esophageal and periesophageal injury (mucosal lesions, food retention, periesophageal edema, or vagal nerve injury) were assessed following PFA and radiofrequency (RF)- or cryoballoon (CB)-PVI.

Atrial Fibrillation 40

Atrial Fibrillation Ablation Ultrasound Pulmonary 40

Stroke Journal

FEBRUARY 1, 2024

All patients had standard TTE and an rTCD (NovaSignal) with saline bubble injection at rest and Valsalva strain for assessment of RLS performed by echo and ultrasound technicians. Average age was 55.7 ± 11.1

Stroke 40

Stroke Strokes Ultrasound Risk Factors 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. 2022 ; 51 : 384 - 387 3. 2022 ; 55 : 180 - 182 6.

Chest Pain 120

Chest Pain STEMI Electrocardiogram Ischemia 120

Dr. Paddy Barrett

DECEMBER 19, 2023

2 High intensity interval training induces beneficial effects on coronary atheromatous plaques – a randomized trial, European Journal of Preventive Cardiology , 2022;, zwac309, 3 The effects of lipid-lowering therapy on coronary plaque regression: a systematic review and meta-analysis. Springer, Cham. Sci Rep 11 , 7999 (2021).

Coronary Artery Disease 105

Coronary Artery Disease Plaque Exercise Heart Attack 105

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Pads were placed with ultrasound guidance, so they were in the correct position. As I discussed and documented in Lesson 1 of My Comment at the bottom of the page in the April 2, 2022 post of Dr. Smith's ECG Blog — certain patients may remain in sustained VT not only for hours — but even for days! However, this is not SVT.

Tachycardia 136

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 136

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Fortunately, this operator used intravascular ultrasound (IVUS). NOTE: For review of 20 cases of "Swirl" vs Swirl "Look-Alikes" — Check out the October 15, 2022 post in Dr. Smith's ECG Blog. An angiogram is a " lumenogram " and does not "see" the extraluminal plaque. Most plaque is outside the lumen!!

Plaque 70

Plaque Stents Stent Chest Pain 70

Dr. Smith's ECG Blog

DECEMBER 18, 2022

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

Chest Pain 40

Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. NOTE: For more on the ECG diagnosis of acute RV "strain" ( and acute PE ) — Please check out My Comment at the bottom of the page in the March 28, 2022 post in Dr. Smith's ECG Blog.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The April 17, 2022 post ( Leads V1,V2 misplacement ). The May 24, 2022 post ( LA-LL reversal ). The May 26, 2022 post ( LA-LL reversal ). The August 17, 2022 post ( LA-RA reversal ). RVMI explains part of the shock.

Chest Pain 78

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 78

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

We report our experience validating this large animal model for translational and preclinical research.Methods3 animal experiments were performed at the UCLA TRIC laboratory between 02/2022 and 10/2022. The sheep were anesthesitized and handled under approval of the Animal Research Committee at UCLA (protocol ARC 2020‐19).

Laboratory 40

Laboratory Ultrasound Research Stenosis 40

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. Takotsubo is a sudden event, not one with crescendo angina.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. Thus, intracoronary imaging modalities are crucial in this setting.

Coronary Angiogram 100

Coronary Angiogram Plaque Thrombosis STEMI 100

Dr. Smith's ECG Blog

MARCH 6, 2023

Regional wall motion abnormality-inferolateral (this is the formal ultrasound location of a posterior wall motion abnormality). 2022 ACC expert consensus decision pathway on the evaluation and disposition of acute chest pain in the emergency department: A report of the American college of cardiology solution set oversight committee. •

Chest Pain 52

Chest Pain STEMI Stenosis Blog 52

Dr. Smith's ECG Blog

DECEMBER 3, 2024

Case continued A bedside cardiac ultrasound revealed grossly preserved left ventricular function, no appreciable wall motion abnormality, pericardial effusion, or obvious valvular abnormality. The terminal part of the T-wave is inverted in lead III, and reciprocally terminally upright in lead aVL.

Catheterization Laboratory 96

Catheterization Laboratory STEMI Blog Ischemia 96

Dr. Smith's ECG Blog

JULY 21, 2024

Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance. Meyers and Smith illustrate 20 example cases vs "look-alikes" of Swirl ( with my synthesis of "Swirl" ECG findings in My Comment on that post ) from October 15, 2022.

Arrhythmia 113

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 113

Dr. Smith's ECG Blog

OCTOBER 17, 2024

I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE.

Chest Pain 77

Chest Pain STEMI Pulmonary Embolism 77

Dr. Smith's ECG Blog

APRIL 25, 2023

No pericardial effusion on ultrasound." We've previously discussed the all-too-often ignored entity known as MINOCA ( = MI with N on- O bstructive C oronary A rteries ) — which we detailed in the November 30, 2022 post in Dr. Smith's ECG Blog ( See My Comment at the bottom of the page ). What do you think?

Chest Pain 52

Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Dr. Nossen performed a bedside ultrasound which was interpreted as normal. For readers not familiar with this format — I've reviewed its features in the Addendum at the bottom of the page in the April 24, 2022 post in Dr. Smith's ECG Blog. Nossen, who practices in Norway — today's ECG uses the Cabrera Format.

Blog 52

Blog Bradycardia Ischemia Exercise 52

Dr. Paddy Barrett

NOVEMBER 7, 2023

You use an ultrasound. Nat Rev Cardiol 19 , 168–179 (2022). Regardless of the murmur findings they describe. Because using the sounds of a murmur you hear with a stethoscope that was invented in the 1700s is NOT how you make a diagnosis today. Which can now be used easily at the bedside. i.e. You DO NOT GUESS! Shapiro, M.D.

Cholesterol 52

Cholesterol Atherosclerosis Stenosis Aortic 52

Dr. Anish Koka

JULY 23, 2023

A lower extremity arterial ultrasound revealed elevated velocities in the right proximal superficial femoral artery. A second opinion from another physician at another facility resulted in a normal ultrasound. The resulting investigation and sanction to suspend his medical license did not take place until late in 2022.

Vascular Care 52

Vascular Care Outpatient Peripheral Arterial Disease Stents 52

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. A emergent cardiology consult can be helpful for equivocal cases.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

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. The October 21, 2022 post — for " artifactual VT". Smith comment: this is diagnostic of OMI until proven otherwise. The March 17, 2023 post — for PTA.

Chest Pain 67

Chest Pain Blog Critical Care Arrhythmia 67

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. The beat-to-beat variation in QRS amplitude and morphology is electrical alternans. This patient is only pseudo-stable. She has already had syncope.

Pericarditis 40

Pericarditis Tachycardia Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

JUNE 2, 2023

My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG? Please see My Comment in the May 14, 2022 post for a regular WCT that turned out to be antidromic AVRT.

Tachycardia 75

Tachycardia Cardiomyopathy Electrocardiogram Article 75

Dr. Anish Koka

SEPTEMBER 24, 2022

This latest data dump did not arrive soon enough to affect the ACIP committee’s recommendations but should serve to chill the ambition of exuberant, overconfident bureaucrats still seeking to mandate vaccines in the fall of 2022. That work is far from complete. Anish Koka is a cardiologist.

COVID-19 52

COVID-19 Hospital Chest Pain Quality of Life 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

Clin Cardiol 2022; [link] Labs included: hsTnI 156 ng/L, Hb 12 g/dL, WBC 12x10^9/L, Cr. Smith comment: Point of Care ultrasound is not adequate to rule out wall motion abnormality; moreover, diffuse subendocardial ischemia often has no wall motion abnormality because the epicardium is still contracting. Lupu L, et al. mg/dL, K 3.5

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

PMID: 34775811; PMCID: PMC9075358 A bedside ultrasound was performed, shown here: Parasternal short axis view demonstrating inferior LV wall motion akinesis Apical 2 chamber view again demonstrating inferior LV wall akinesis The cath lab was not activated based on the ECG and bedside echo. J Am Heart Assoc. 2021 Dec 7;10(23):e022866.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 15, 2023

Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. 25, 2022 ). But when you see this, you should suspect that the AV node is not well. I signed her out to one of my partners. He decided to give ibutilide 1 mg over 10 minutes.

Atrial Fibrillation 52

Atrial Fibrillation AFIB Arrhythmia Exercise 52