BoardVitals - Cardiovascular

SEPTEMBER 29, 2017

Which of the vessels likely provides blood supply to the circled area in the below polar plot image in a patient with normal coronary anatomy? The images demonstrate a moderately extensive, mildly severe reversible defect in the mid and distal anterior/anterolateral wall consistent with ischemia. The technologist performs a MUGA scan.

Chest Pain 52

Chest Pain Certification Ischemia General Cardiology 52

DAIC

OCTOBER 1, 2024

tim.hodson Tue, 10/01/2024 - 10:50 PHOTO CAPTION: The Elucid PlaqueIQ user interface is a fully interactive visualization of the patient’s coronary anatomy, showing specific plaque type and amount across various views to inform physician assessment of risk and patient-specific treatment pathway. Cardiovasc. 6 (3) (2019).

Cardiovascular Disease 52

Cardiovascular Disease Plaque Quality of Life Myocardial Infarction 52

Ken Grauer, MD

FEBRUARY 18, 2023

Shark Fin" ST segment elevation is most often a sign of severe transmural ischemia that results from acute coronary occlusion. Consideration of prompt cardiac cath is essential for clarifying the anatomy — since in many ( most ) cases, prognosis is likely to be poor unless there is prompt reperfusion. (

Blog 78

Blog AFIB Chest Pain STEMI 78

Ken Grauer, MD

MARCH 7, 2023

This qualifies as " dynamic " ST-T wave change — and in a patient with new chest pain, this is indication for prompt cath to define the anatomy and ensure reperfusion. 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 ).

Blog 78

Blog Chest Pain STEMI Ischemia 78

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

For example, inferior OMI with concomitant critical stenosis produces a combined pattern ( Aslanger’s pattern ) with inferior STE and subendocardial ischemia · occlusion of two infarct-related arteries simultaneously ("co-culprits") In this case there were two infarct-related arteries.

Chest Pain 52

Chest Pain STEMI Ischemia Stenosis 52

Dr. Smith's ECG Blog

JUNE 28, 2019

For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%. More likely, these T waves probably reflect ischemia of uncertain age. It was stented.

Chest Pain 52

Chest Pain Pericarditis Stents Stent 52

Dr. Smith's ECG Blog

AUGUST 15, 2019

Ongoing ischemia (by symptoms, ECG, or troponin) despite maximal medical management is an indication for emergent cath lab activation. == MY Comment by K EN G RAUER, MD ( 8/15/2019 ): == Once again, the w rong q uestion was a sked in this case. Any Q-wave in V2 in the presence of an otherwise normal QRS complex is abnormal.

STEMI 52

STEMI Chest Pain Risk Factors Anatomy 52

Dr. Smith's ECG Blog

AUGUST 28, 2020

This is ischemia until proven otherwise. A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock. I learned that the patient is on Sotalol for control of PVCs. This explains the long QT.

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

Dr. Smith's ECG Blog

AUGUST 9, 2018

ACTUAL CORONARY ANATOMY: Dominance: Right LM: A 5 mm vessel which bifurcates into the LAD and LCx coronary artery. 2) There are three causes of tall T waves; hyperkalemia, hyperacute ischemia and normal variant (Atlas of Electrocardiography by K. Wang, (pages 222-224). Wang, page 171).

STEMI 52

STEMI Chest Pain RN Anatomy 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). 90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). The patient recovered well. J Am Heart Assoc.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Smith's ECG Blog

OCTOBER 6, 2018

If the patient had been "lucky," his symptoms from the prior day might have been due to ischemia prolonged and intense enough to result in small troponin increase. The anatomy and lead placement create very small voltage compared to the other main coronary distributions. EF was 55%. The patient did well at least in the short term.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Coronary Artery Disease (CAD) CAD, which involves the narrowing or blockage of coronary arteries due to plaque buildup, can reduce blood flow to the heart.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Ken Grauer, MD

SEPTEMBER 21, 2024

These include coronary artery spasm ( as may be precipitated by cocaine use or binge alcohol drinking ) — myocardial bridging ( that may be the cause of intermittent acute ischemia ) — aberrant anatomy of a coronary artery ( which may present with sudden rupture causing acute infarction or sudden death at any age! ).

Chest Pain 119

Chest Pain Blog Thrombosis Tachycardia 119

DAIC

MARCH 25, 2024

Session 510) To Treat or Not to Treat Anatomy and Ischemia? (Session 508) Battle of the Imagers - Jeopardy Edition! Session 509) Who Wants to Be a Millionaire in Eradicating Vascular Medicine Disparities?

Education 59

Education Cardiogenic Shock Heart Failure Plaque 59

MIBHS

OCTOBER 15, 2024

Additionally, the heart’s high demand for oxygen makes it particularly vulnerable to conditions like ischemia (reduced blood flow), which can weaken or damage the heart muscle if left untreated. Common Problems in Coronary Circulation Understanding coronary circulation helps shed light on common heart conditions.

Circulation 52

Circulation Heart Attack Heart attacks Chest Pain 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

This ECG is all but diagnostic of subepicardial ischemia of the anterior, lateral, and inferior walls, most likely due to Occlusion MI (OMI), probably of the LAD. because if it does, then urgent cath to define the anatomy is clearly indicated. Here is his ECG on arrival: What do you think? Leads II and aVF also have hyperacute T-waves.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

These include coronary artery spasm ( as may occur from cocaine use or binge alcohol drinking ) — myocardial bridging ( that may be the cause of intermittent acute ischemia ) — aberrant anatomy of a coronary artery ( which may present with sudden rupture causing acute infarction or sudden death at any age! ).

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. S. Venkatesan MD

APRIL 6, 2025

We know, stress tests can give false positive results suggesting ischemia in at least 20% of patients for various reasons. We are obsessed with anatomy. Our flawed intellect keeps asking this question: How can I trust physiology (Flow) without documenting a good anatomy? In fact, truth is the other way around.

Anatomy 52

Anatomy Physiology Document Academic 52

Dr. Smith's ECG Blog

DECEMBER 3, 2024

Given the right coronary anatomy seen during angiography, it is particularly interesting that subtle T wave changes were seen on the previous EKGs in the high lateral leads that would otherwise only be expected with a more proximal RCA lesion. Also: electrical instability, pulmonary edema, or hypotension.

Catheterization Laboratory 110

Catheterization Laboratory STEMI Blog Ischemia 110

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

That said there were no clinical symptoms or ECG findings suggestive of ongoing ischemia. You have given IV MgSO4 a fast acting -blocker and IV amiodarone bolus and infusion. The possibility of an ischemic cause of the ventricular arrhythmia has to be considered! Troponin T was negative on admission and on repeat blood draw.

Tachycardia 72

Tachycardia Arrhythmia Atrial Flutter Ablation 72