DAIC

FEBRUARY 13, 2024

High Diagnostic Accuracy Of AI-Ischemia in Comparison To PET, FFR-CT, SPECT, and Invasive FFR: A PACIFIC Sub-Study. Presented at the American College of Cardiology Annual Scientific Meeting New Orleans LA 2023. Presented at the Society of Cardiovascular Computed Tomography Annual Scientific Meeting Boston MA 2023.

Coronary Artery Disease 103

Coronary Artery Disease Ischemia Atherosclerosis Cardiovascular Imaging 103

DAIC

MARCH 20, 2024

The Freesolve BTK RMS is designed for individuals suffering from chronic limb-threatening ischemia (CLTI). Updated estimates for the burden of chronic limb-threatening ischemia in the Medicare population, Journal of Vascular Surgery, Volume 77, Issue 6, 2023, 1760-1775 2 Seguchi M., 4 Seguchi M.,

Peripheral Arterial Disease 105

Peripheral Arterial Disease Innovation Technology Coronary Artery Disease 105

DAIC

MARCH 27, 2025

ii to show blood flow through the heart muscle and evaluate the presence, extent and degree of myocardial ischemia or infarction. 2023 Oct, 82 (16) 15981610. Around 6 million MPI procedures are undertaken each year in theU.S. Flyrcado is now available in selectU.S.markets. Click here to learn more about Flyrcado. link] ii Miller, R.

Coronary Artery Disease 52

Coronary Artery Disease CMS Innovation Ischemia 52

Society of Thoracic Surgeons - Allied Health

FEBRUARY 14, 2023

2023 STS Coronary Conference Agenda gtrainyte Tue, 02/14/2023 - 09:13 Session titles and presenters are subject to change. Sabik III, MD, Cleveland, OH, USA Sigrid Sandner, MD, Vienna, Austria David Glineur, MD, PhD, Ottawa, ON, Canada Building an Advanced Coronary Surgery Program Day 1: Saturday, June 3, 2023 7:00 a.m. –

Coronary Artery Bypass Graft 52

Coronary Artery Bypass Graft Atrial Fibrillation Outcomes Stent 52

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 118

Chest Pain Ischemia Echocardiogram Myocardial Infarction 118

Ken Grauer, MD

DECEMBER 15, 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).

Blog 151

Blog STEMI Ischemia Chest Pain 151

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. IntroductionAcute spinal cord ischemia syndrome (ASCIS) is a rare disease that is thought to comprise roughly only 1.2% of all strokes [1, 2]. Due to the scarcity of these events, the patient outcomes are unclear.

Ischemia 40

Ischemia Myocardial Infarction Thrombosis Strokes 40

Dr. Smith's ECG Blog

JUNE 5, 2024

The ECG does not show any definite signs of ischemia. This combination is often extremely effective for maintaining good longterm outcome ( Lanza and Shimokawa — Eur Cardiol 18: e38, 2023 ). The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck.

Chest Pain 122

Chest Pain Blog Cardiac Arrest Cardiomyopathy 122

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.” 2024, [link].

Coronary Artery Disease 111

Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

Ken Grauer, MD

JANUARY 13, 2024

My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation." BOTTOM LINE: ECG changes of LV "strain" and/or ischemia that we see on today's initial ECG — were not present 9 years earlier. Please see ECG Blog #73 for additional details ).

Blog 159

Blog Ischemia AFIB Hypertension 159

Dr. Smith's ECG Blog

JULY 30, 2023

The STD maximal in V1-V4 is diagnostic of acute transmural posterior wall ischemia, most likely due to posterior OMI. Subendocardial ischemia does not localize, and subendocardial ischemia presents with STD maximal in V5-6, II, and STE in aVR. Subendocardial ischemia does not localize.

Chest Pain 52

Chest Pain Ischemia STEMI Arrhythmia 52

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). What do you think?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Ken Grauer, MD

DECEMBER 29, 2023

Shark Fin" ST segment elevation is most often a sign of severe transmural ischemia that results from acute coronary occlusion. As a result — the boundary between the end of the QRS complex and the beginning of the ST segment becomes indistinguishable in those leads showing marked ST elevation or depression.

Blog 173

Blog Cardiac Arrest Ischemia Hospital 173

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." QUESTION #2: If it were not for the markedly prolonged QTc — Wouldn't ECG #1 look like diffuse subendocardial ischemia?

Chest Pain 123

Chest Pain Ischemia Cardiac Arrest Blog 123

Dr. Smith's ECG Blog

JANUARY 20, 2024

Instead, pain is numbed and thus ischemia is obscured with opioids, excuses like hypertension are blamed, and unnecessary CT pulmonary angiograms are focused on. Figure-1: The de Winter T Wave Pattern , as first described by Robbert J. de Winter et al in N Engl J Med 359:2071-2073, 2008.

Chest Pain 120

Chest Pain STEMI Hypertension Blog 120

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging. Many health care providers will simply not attempt to assess ischemia in the presence of a wide QRS. In the ECG above there are several features indicative of ongoing transmural ischemia. What do you think?

Chest Pain 111

Chest Pain Pacemaker Ischemia Stent 111

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

Blog 98

Blog Chest Pain Ischemia STEMI 98

Ken Grauer, MD

APRIL 5, 2024

As a result, the ST elevation ( with especially tall, peaked T wave in lead V2) — is not indication of acute ischemia. As suggested by Figure-4 below in the ADDENDUM — assessment of the ST-T waves in leads V2,V3 and V5,V6 — is consistent with ischemia and / or LV "strain".

Blog 94

Blog Ischemia Chest Pain Hypertension 94

Cardiology Update

NOVEMBER 19, 2023

Results revealed ischemia in one cardiac territory in 80% of patients, two territories in 17%, and three territories in 2%. The investigators concluded that in patients with stable angina and minimal medication, confirmed ischemia, and randomized to PCI, the procedure led to better angina outcomes compared to the placebo. N Engl J Med.

Angina 52

Angina Ischemia Article Research 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. You can see in the lead-specific analysis that she "sees" the STD in V5, V5, and II, with STE in aVR as signs of "Not OMI", because subendocardial ischemia pattern is not the same as OMI. In my opinion, I think it looks more like subendocardial ischemia.

Chest Pain 82

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

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 119

STEMI Ischemia Blog Chest Pain 119

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. When we save a limb, we save a life.

Peripheral Arterial Disease 52

Peripheral Arterial Disease Cancer Innovation Best Practices 52

Dr. Smith's ECG Blog

AUGUST 6, 2024

In any case, the ECG is diagnostic of severe ischemia and probably OMI. So this could be myocarditis but in my opinion needs an angiogram before making that diagnosis. == Dr. Nossen Comment/Interpretation: Evaluation of ischemia on an ECG can be very challenging. Concordant STE of 1 mm in just one lead or 2a.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

JANUARY 6, 2024

In the days before I learned to look for OMI, back when I was counting ST elevation boxes, I used to save ischemia for last.) I interpret tracings systematically in "real time" ( including my assessment for acute ischemia ). The January 15, 2023 post ( LA-LL reversal; Lead V1,V2 ). The May 13, 2023 post ( LA-RA reversal ).

Blog 111

Blog Ischemia Tachycardia STEMI 111

Ken Grauer, MD

AUGUST 26, 2023

These tall T waves are associated with flattening ( straightening ) of the ST segment in the inferior leads — with slight S T elevation in leads V2-thru-V6 ( albeit not enough to qualify as a "STEMI" — Akbar et al, StatPearls, 2023 ). This point is discussed in detail in the March 24, 2023 post of Dr. Smith’s ECG Blog ).

Blog 145

Blog Chest Pain STEMI Ischemia 145

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. The ECG does not show any signs of ischemia. True Positive ECG#2 : Also sinus rhythm. There is ST depression in V1.

Ischemia 122

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 122

Dr. Smith's ECG Blog

JANUARY 2, 2025

It should be kept in mind that on occasions, beta-one agonist can result in increased ventricular ectopy e.g., in severe myocardial ischemia (by increasing myocardial demand), or sometimes with congenital long-QT syndrome. Smith, this can be accomplished by either using beta-one agonists or temporary transvenous pacing.

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

Dr. Smith's ECG Blog

MARCH 1, 2023

The precordial STD persists in severity from V4-V6, rather than being maximal in V1-V4 (as in posterior OMI), and so the ECG overall best fits the subendocardial ischemia pattern (diffuse supply/demand mismatch). Instead, diffuse subendocardial ischemia may be present with ST depression in only 7 or 8 leads.

Chest Pain 52

Chest Pain Ischemia Tachycardia Stenosis 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Do you agree with this strategy? How can you better assess the ST segments?

Tachycardia 119

Tachycardia Electrophysiology Atrial Flutter Ischemia 119

Dr. Smith's ECG Blog

DECEMBER 7, 2023

This proves effective treatment of the recurrent ischemia. The patient had no further symptoms of ischemia. EKG 3 is diagnostic for developing re-occlusion, and EKG 4 proves that the nitrates relieved the ischemia. = This proves effective treatment of the recurrent ischemia." Here was her final EKG prior to discharge.

SCAD 124

SCAD Ischemia Coronary Artery Disease Cardiomyopathy 124

Dr. Smith's ECG Blog

APRIL 30, 2024

Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? He was resuscitated into a perfusing rhythm. He went in and out of arrest until arrival at the ED. Instead — these peaked deflections represent part of the ST-T wave!

Blog 107

Blog Ischemia Tachycardia Arrhythmia 107

Ken Grauer, MD

MAY 20, 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).

Blog 145

Blog Chest Pain Ischemia STEMI 145

Dr. Smith's ECG Blog

OCTOBER 23, 2023

PMID: 11723026. == MY Comment , by K EN G RAUER, MD ( 10/23 /2023 ): == The various forms of electrical alternans are frequently misunderstood, if not completely unnoticed. Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Circulation. 2001 Nov 27;104(22):2722-7.

Tachycardia 130

Tachycardia Cardiac Arrest ICU Blog 130

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. Eur Heart J Digital Health 2024 5. McLaren and Smith.

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

Dr. Smith's ECG Blog

MAY 3, 2024

When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). There is STE in aVR. Thus, there is high lateral OMI with diffuse ST depression. Moreover, left main occlusion often presents near death.

Cardiogenic Shock 126

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 126

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.

Blog 137

Blog Cardiac Arrest Atrial Fibrillation Bradycardia 137

Dr. Smith's ECG Blog

NOVEMBER 27, 2023

The admission and discharge diagnosis both attributed the ECG changes and echo findings to ischemia. baseline ECGs may fluctuate over time, and not necessarily represent dynamic ischemia 4. Below is the discharge ECG, which showed the baseline ECG without any reperfusion T wave inversion. Take home 1. I'd add the following to Dr.

Chest Pain 110

Chest Pain STEMI Ischemia Anatomy 110