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 127

Cardiogenic Shock Cardiac Arrest Hospital Ischemia 127

Dr. Smith's ECG Blog

JULY 21, 2024

There is no definite evidence of acute ischemia. (ie, Distinction of PMVT vs VFib is an academic one in this case ). Simply stated — t he patient was having recurrent PMVT without Q Tc prolongation, and without evidence of ongoing transmural ischemia. ( Some residual ischemia in the infarct border might still be present.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Most such rhythms in the setting of ischemia are VF and will not convert without defibrillation. This distinction is more than academic — because both treatment and the response to therapy tend to be different with these 2 entities. Acute ischemia? Case continued The tachyarrhythmia terminated on its own. g IV dose of Magnesium.

Cardiac Arrest 122

Cardiac Arrest Tachycardia Cardiomyopathy Bradycardia 122

Dr. Smith's ECG Blog

JUNE 13, 2024

V1 sits over both the RV and the septum, so transmural ischemia of either one with give OMI pattern in V1 and reciprocal STD in V5 and V6. After being transferred to an academic center, she was taken to the cath lab: Proximal RCA occlusion (causing inferior and RV OMI) Unfortunately, she continued to decline despite aggressive measures.

Chest Pain 92

Chest Pain Document STEMI Defibrillator 92

Stroke Journal

NOVEMBER 9, 2023

A combined effort from academic investigators, industry, and regulators is needed to improve imaging technologies and, ultimately, patient outcomes. Imaging in acute ischemic stroke treatment has advanced significantly, but important challenges remain that need to be addressed.

Stroke 40

Stroke Strokes Academic Thrombolysis 40

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. There seems to be a non-academic indication for doing this study to undo the damage done by ORBITA-1.

Angina 52

Angina Academic Stenosis Article 52

Stroke Journal

FEBRUARY 1, 2024

Objective:To assess whether diffusion restriction (DR) of the retina and optic nerve (ON) can be accurately and reliably identified on standard stroke protocol brain magnetic resonance diffusion-weighted imaging (DWI-MRI) in patients presenting with acute non-arteritic central retinal artery occlusion (CRAO).Background:Retinal

Ischemia 40

Ischemia Academic Education Stroke 40

Dr. Smith's ECG Blog

MAY 31, 2023

There is probably a trickle of flow which is why there is both subendocardial ischemia (ST depression) and early subepicardial ischemia (hyperacute T-waves). Academic Emergency Medicine 27(S1): S220; May 2020. I sent the last one to the Queen of Hearts #PMCardio app and here is the verdict: My response: "It’s not even subtle.

STEMI 96

STEMI Chest Pain Myocardial Infarction Ischemia 96

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Smith : the profound persistent STE suggests either persistent occlusion or " no reflow " with persistent downstream ischemia. It makes you think you have done something for the ischemia when you have not! Academic Emergency Medicine 27(S1): S220; May 2020. Setting – large, academic, suburban ED. Abstract 556.

STEMI 78

STEMI Myocardial Infarction Ischemia Academic 78

DAIC

OCTOBER 16, 2024

The COMPARE 60/80 HBR trial is the first randomized clinical trial conducted after the release of the ARC HBR (Academic Research Consortium for High Bleeding Risk) guidelines, enrolling only HBR patients as defined by these criteria.

Stent 52

Stent Stents Thrombosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. Academic Emergency Medicine 27(S1): S220. Smith comment: There is a change in V2 as well, with less normal STE and a smaller T-wave with some inversion.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

DAIC

JANUARY 3, 2024

Traditional methods of non-invasive ischemia testing (stress EKG , stress echo, SPECT , PET , direct-to-cath) can result in false negatives 20-30 percent of the time, which can lead to undetected disease, and false positives over 50 percent of the time, which can lead to unnecessary invasive procedures.

Coronary Artery Disease 59

Coronary Artery Disease Chest Pain Plaque Technology 59

Dr. Smith's ECG Blog

APRIL 22, 2019

It does not usually represent subendocardial ischemia, but rather it is usually reciprocal ST depression, reciprocal to inferior ST elevation. The generalities stated here for predicting ischemia are much more likely to apply when other factors are minimal. Had episode of nausea and dizziness when it started. Sounds like reflux, right?

Chest Pain 52

Chest Pain Arrhythmia Ischemia STEMI 52

Dr. Smith's ECG Blog

JANUARY 22, 2020

There was no evidence of ischemia. In the interest of academic discussion Ill present a nother p erspective on selected aspects this case. We are not told how ischemia has been ruled out in this case. They clearly do not s uggest acute coronary occlusion but they are consistent with ischemia. Hyperkalemia.

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Pulmonary AFIB Atrial Fibrillation Pacemaker 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern). This is "shark fin" morphology. Code STEMI was activated. Eur Heart J.

Chest Pain 52

Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 19, 2018

This confirms that there were dynamic signs of ischemia on the initial ECG. In the interest of academic discussion — I’ll add the following thoughts: The computer interpretation was obviously wrong. Note that the ST elevation in the inferior leads has basically resolved, especially compared with the restored QRS voltage.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

Ken Grauer, MD

MARCH 29, 2023

For the EP cardiologist — localization of the AP before EP study is more than academic, as it facilitates and expedites localization of the AP during EP study. ECG Blog #157 — Can you diagnose ischemia and/or infarction when there is WPW? ECG Blog #87 — Reviews a case of WPW with intermittent AP conduction.

Blog 78

Blog AFIB Arrhythmia Download 78

Dr. Smith's ECG Blog

APRIL 29, 2020

PEARL #2 — Distinction between PMVT vs Torsades is more than academic. Instead, antiarrhythmic drugs such as amiodarone or ß-blockers may be needed — and/or treatment targeted to correcting ischemia. Acute ischemia? Both treatment and the response to therapy tends to be different with these 2 entities.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. He called 911. Here is the prehospital ECG. What do you think?

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Aneurysm Chest Pain Cardiogenic Shock Blog 66

Dr. Anish Koka

MAY 16, 2023

The diagnosis typically requires classic clinical features, with no evidence of obstructive coronary disease, and typical findings of ischemia on functional studies. This happens. But its rare! A clinician with any grasp on reality would work up men, on average, more aggressively for coronary disease than women.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

JUNE 23, 2023

The amiodarone was discontinued and the patient did well. == MY Comment , by K EN G RAUER, MD ( 6/23 /2023 ): == From an academic standpoint — I love WCT ( W ide- C omplex T achycardia ) rhythms. Next day, the cardiologists were convinced (I think correctly) that this was SVT with aberrancy that was triggered by DKA.

Tachycardia 52

Tachycardia Cardiomyopathy Arrhythmia Diabetes 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. Academic Emergency Medicine., Academic Emergency Medicine, 2003 Volume 10, Number 5 539-540. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia. 2nd or 3rd degree AV blocks or sinus pause of at least 2 seconds iv. Left BBB vi.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

MARCH 14, 2025

This case highlights how T-waves are very important in the assessment of ischemia and dynamic changes in acute coronary syndrome. I have often seen colleagues worry about T-wave inversions as a sign of ongoing ischemia. Academic Emergency Medicine 27(S1): S220; May 2020. See this case: A man his 50s with chest pain.

Chest Pain 106

Chest Pain STEMI Myocardial Infarction Ischemia 106

Dr. S. Venkatesan MD

FEBRUARY 3, 2025

It is a strange academic habit among cardiologists, that they have subdivided medical management into optimal and suboptimal. Academic lessons from this patient. The therapeutics of coronary stenosis has become a technogical wonder, interwoven with statistical wordplay in the last few decades. 2016 Dec;9(12):e003726.

Stent 52

Stent Stents Academic Ischemia 52