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. link] References 1. Amsterdam et al.

STEMI 120

STEMI Chest Pain Myocardial Infarction Blog 120

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. IntroductionMechanical thrombectomy (MT) has demonstrated a significant improvement in functional outcomes for patients with anterior circulation strokes and large‐vessel occlusion (LVO).

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Stroke Strokes Outcomes Ischemia 40

Stroke Journal

JANUARY 30, 2025

Collateral status is a well-documented marker of reperfusion and mortality in patients with large vessel occlusion (LVO) anterior circulation strokes, which account for approximately one-third of AIS. Methods:We retrospectively evaluated AIS patients treated at our institution between January 2017 and January 2023.

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Document Circulation Stroke Strokes 40

Dr. Smith's ECG Blog

JANUARY 1, 2024

Learning Point: Concordant ST segment elevation can arise from profound ischemia triggered by ventricular tachycardia (VT), or it may represent an exaggerated basal ST change accompanying tachycardia. The patient rapidly regained consciousness, reporting no residual pain. A peak troponin level of 70 ng/L was observed.

Tachycardia 111

Tachycardia Blog Ischemia Heart Failure 111

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. ORBITA-2 came in 2023. 2023 Dec 21;389(25):2319-2330. Epub 2023 Nov 11. What happened ?

Angina 52

Angina Academic Stenosis Article 52

Circulation: Cardiovascular Imaging

NOVEMBER 20, 2023

Circulation: Cardiovascular Imaging, Volume 16, Issue 11 , Page e015800, November 1, 2023. of patients had evidence of ischemia on a prior functional test. were referred to CCTA and 22.5% In the follow-up ranging from 1 to 3.5 years, 660 of the 2928 patients randomized to CCTA first underwent ICA (23%). 0.98];P=0.043).

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Chest Pain Myocardial Infarction Cardiovascular Imaging Ischemia 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. Safety and efficacy of mechanical thrombectomy in posterior circulation MVO is unclear compared to medical treatment only (1). IntroductionPosterior Cerebral Artery (PCA) is a medium vessel occlusion (MVO) which is 5‐10% of all acute ischemic events.

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Stents Stent Ischemia Embolism 40

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.

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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.

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Coronary Angiogram Plaque Thrombosis STEMI 109

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. Surgical procedures include an endarterectomy on the ipsilateral ECA or contralateral ICA to increase collateral circulation.

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Stroke Strokes Stents Stent 40

Ken Grauer, MD

MARCH 7, 2023

ECG Blog #184 — illustrates the "magical" mirror-image opposite relationship with acute ischemia between lead III and lead aVL ( featured in Audio Pearl #2 in this blog post ). ECG Blog #271 — Reviews determination of the ST segment baseline ( with discussion of the entity of diffuse Subendocardial Ischemia).

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Blog Chest Pain STEMI Ischemia 78

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. link] == MY Comment , by K EN G RAUER, MD ( 12/26/ 2023 ): == Interesting case by Dr. Frick — with superb illustration by him of cardiac cath findings!

Chest Pain 129

Chest Pain Myocardial Infarction Blog Stents 129

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

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. My Comment by K EN G RAUER, MD ( 1/23 /2023 ): = The importance of today's case by Drs.

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Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 15, 2023

My Comment by K EN G RAUER, MD ( 3/15 /2023 ): = I found today’s case highly instructive in highlighting a number of important aspects regarding the presentation and initial treatment of a patient who presents to the ED with new AFib. Ballatore et al — Medicina (Kaunas) 55(8): 497, 2019 — and — Page et al — Circulation 107:1141-1145, 2003 ).

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Atrial Fibrillation AFIB Arrhythmia Exercise 52

DAIC

MAY 8, 2024

6 This novel study marks a significant milestone in the field, evaluating the effectiveness of FFR CT in detecting ischemia-producing coronary stenosis in patients with severe PAD. Diagnosis and treatment of ischemia-producing coronary stenoses improves 5-year survival of patients undergoing major vascular surgery.” Circulation, vol.

Coronary Artery Disease 111

Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

DAIC

FEBRUARY 14, 2025

Critical limb-threatening ischemia (CLTI) represents the end stage of peripheral artery disease (PAD), when poor circulation due to blockages in the arteries causes symptoms including numbness, sores that will not heal, gangrene, and extreme pain.

Peripheral Arterial Disease 52

Peripheral Arterial Disease Cancer Innovation Best Practices 52

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 As of June 2023, the U.S. 2020 Jan 28;141(4):e60] [published correction appears in Circulation.

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Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

AUGUST 10, 2023

But two features were concerning: An ECG showing reperfusion indicates high risk for reocclusion – either from a transiently open artery at risk of closing, or an artery that is still occluded but with perfusion tenuously maintained by collateral circulation The patient had ongoing ischemic symptoms, suggesting ongoing occlusion. Shroff, G.

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Chest Pain STEMI Ischemia Nursing 98

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). The physiologic reason for this — is thought to be the result of momentarily increased circulation from mechanical contraction arising from the "sandwiched in" QRS complex. The QRS complex in ECG #1 is wide.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 106

Circulation

OCTOBER 18, 2023

Circulation, Volume 148, Issue 24 , Page 1919-1928, December 12, 2023. The primary efficacy outcome was a composite of acute limb ischemia, major amputation of a vascular pathogenesis, myocardial infarction, ischemic stroke, or cardiovascular death. mg of rivaroxaban BID or matching placebo and 100 mg of aspirin daily.

Peripheral Arterial Disease 40

Peripheral Arterial Disease Myocardial Infarction Thrombolysis Ischemia 40

DAIC

FEBRUARY 14, 2025

Critical limb-threatening ischemia (CLTI) represents the end stage of peripheral artery disease (PAD), when poor circulation due to blockages in the arteries causes symptoms including numbness, sores that will not heal, gangrene, and extreme pain.

Hospital 52

Hospital Peripheral Arterial Disease Cancer Innovation 52

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. 2023 Nov-Dec;23(6):171-176. The second reason is, NDCM is a progressive primary muscle disease. Still, our understanding is largely incomplete. 2022 Feb 8;145(6):427-436.

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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]:

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

DAIC

FEBRUARY 7, 2024

FAHA, a past president of the American Heart Association and American Stroke Association, who passed away in January 2023. who was the founding chairman of the American Heart Association’s International Conference on Stroke and Cerebral Circulation, now known as the International Stroke Conference. Sacco, M.D., Steven Warach, M.D.,

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Stroke Strokes Research Health Disparities 105

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. Following EVT, successful recanalization defined as modified TICI (thrombolysis in cerebral ischemia) scores of 2b/3 was achieved in 56 cases (98.2%) with 1 being the median number of passes (IQR 1‐2). Most of the patients had MCA occlusion (68.4%

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Thrombolysis Ischemia Hemorrhage Stroke 40

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.

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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 angiogram showing a "hypoplastic" RCA and dominant LCx ( with distinction between what is a "smaller" RCA in a left-dominant circulation vs an RCA with a lumen that is "too small" sometimes being difficult ). 2022, September 2) [2] Ward, R.

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Tachycardia Arrhythmia Ablation Atrial Flutter 71

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.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74