Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This usually represents posterior OMI, but in tachycardia and especially after cardiac arrest, this could simply be demand ischemia, residual subendocardial ischemia due to the low flow state of the cardiac arrest. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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?

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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.

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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.

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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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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.

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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.

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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.

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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.

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