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). Opiates are associated with worse outcomes in Myocardial Infarction. Academic Emergency Medicine 27(S1): S220; May 2020. Am Heart J. 2005;149:1043–1049.

STEMI 96

STEMI Chest Pain Myocardial Infarction Ischemia 96

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

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. Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. Academic Emergency Medicine 27(S1): S220. Abstract 556.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 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. Thus, this ECG predicts poor myocardial perfusion and poor outcome.

Aneurysm 65

Aneurysm Chest Pain Cardiogenic Shock Blog 65

Dr. S. Venkatesan MD

APRIL 8, 2025

Inference Established that FFR-guided PCI is superior to angiography-guided PCI in multivessel CAD, reducing unnecessary revascularizations and improving outcomes. for PCI vs. 6.9% 5 years later in 2025 FAME 3 : 5 year follow up data , released in 2025, tries to confirm the non inferiorty of PCI over CABG in a larger sense. Reference 1.Fearon

Academic 40

Academic Coronary Artery Bypass Graft Coronary Artery Disease Stents 40

DAIC

APRIL 2, 2025

Dr. Stone is Director of Academic Affairs for the Mount Sinai Health System and Professor of Medicine (Cardiology) and Professor of Population Health Science and Policy at the Icahn School of Medicine at Mount Sinai, and the study chair of the ECLIPSE trial. These results extend the strong recommendations from recent U.S.

Stents 40

Stents Stent Outcomes Coronary Angiogram 40

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished. First , there can simply be diffuse ST depressions (which obligates reciprocal STE in aVR) associated with tachycardia which are not indicative of ischemia.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

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 91

Chest Pain Document STEMI Defibrillator 91

Dr. Anish Koka

MAY 16, 2023

Soviet biologist Trofim Lysenko famously rejected the objective reality of Mendelian genetics because it clashed with the Marxist philosophy that the environment, not genetics, was the primary determinant of outcomes. But what should matter is outcomes not diagnoses. Subscribe for free to receive new posts and support my work.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Evidence of acute ischemia (may be subtle) vii. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS. Abnormal ECG – looks for cardiac syncope. Left BBB vi. Pathologic Q-waves viii.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 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. Here is evidence for this: Opiates are associated with worse outcomes in Myocardial Infarction. Am Heart J.

Chest Pain 105

Chest Pain STEMI Myocardial Infarction Ischemia 105