Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Important point: when there is diffuse subendocardial ischemia but no OMI, a wall motion abnormality will not necessarily be present. They agreed ischemia was likely in the setting of demand given DKA and infection. That this is all demand ischemia is unlikely. Lung exam showed diffuse B lines bilaterally. Aslanger's pattern.

Chest Pain 119

Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch).

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

DAIC

JANUARY 23, 2024

Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 1,2 ASCVD causes or contributes to conditions that include coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease (inclusive of aortic aneurysm).3

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

DECEMBER 7, 2023

I quickly reviewed the patient’s records and saw that she was a 53 year old woman with a history of BMI 40, but no other identifiable risk factors for coronary artery disease. This proves effective treatment of the recurrent ischemia. The patient had no further symptoms of ischemia.

SCAD 124

SCAD Ischemia Coronary Artery Disease Cardiomyopathy 124

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging. What do you think?

Chest Pain 111

Chest Pain Pacemaker Ischemia Stents 111

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Detailed coronary artery evaluation not performed. This suggests further severe ischemia.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Coronary Artery Disease Journal

MARCH 7, 2024

Background Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year. Databases were searched for relevant articles published before 10 November 2023. 0.83) and target-vessel revascularization (OR 0.72; CI 0.53–0.97).

Myocardial Infarction 40

Myocardial Infarction Ischemia Thrombosis Stents 40

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. The patient’s angiogram should have been expedited, but the EKG change was not recognized as recurrence of transmural ischemia.

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. IntroductionTransient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction.

Diabetes 40

Diabetes Coronary Artery Disease Atrial Fibrillation Dementia 40

Dr. Anish Koka

MAY 16, 2023

Diamond and Forrester accomplished this by first establishing the prevalence of coronary artery disease based on how clinically likely patients with chest pain symptoms were found to have coronary disease based on a coronary angiogram. Thanks for reading Dr. Anish Koka's Newsletter! This happens.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Paddy Barrett

DECEMBER 5, 2023

The logic of stenting obstructed coronary arteries is simple. The artery is blocked. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. Subscribe now 1 ISCHEMIA Research Group.

Stents 59

Stents Stent Angina Heart Attack 59

Wellnest

DECEMBER 11, 2023

World AIDS Day 2023 Introduction: World AIDS Day 2023 serves as a poignant reminder of the ongoing global battle against HIV/AIDS, urging us to reflect on the progress made and the challenges that persist. ST-Segment Changes: Changes in the ST segment of an EKG can be indicative of myocardial ischemia or infarction.

Quality of Life 52

Quality of Life Myocardial Infarction Public Health Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 31, 2024

Written by Pendell Meyers A woman in her 70s with known prior coronary artery disease experienced acute chest pain and shortness of breath. One could argue or wonder if there is both subendocardial ischemia AND posterior OMI pattern, since the STD in V4 may be equal or possibly slightly worse proportionally than V6.

Ischemia 119

Ischemia Tachycardia Chest Pain STEMI 119

CardiacWire

JANUARY 10, 2025

A recent study out of UCLA added to the growing body of evidence supporting AI-assisted CCTA as an alternative to SPECT for diagnosing obstructive coronary artery disease, especially in women. SPECT continues to be a first-line test to diagnose coronary ischemia, often instead of or before invasive coronary angiography.

Coronary Artery Disease 59

Coronary Artery Disease Ischemia Chest Pain Reimbursement 59

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 scan showed a bicuspid aortic valve with severe stenosis and coronary artery disease. What "initiates" the aortic stenosis cascade?

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

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! Circumstances attending 100 sudden deaths from coronary artery disease with coroners necropsies. Kashou, A.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75