Ken Grauer, MD
OCTOBER 21, 2023
Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). To EMPHASIZE: This pattern of diffuse Subendocardial Ischemia does not suggest acute coronary occlusion ( ie, it is not the pattern of an acute MI ).
Dr. Smith's ECG Blog
NOVEMBER 4, 2022
The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. His response: “subendocardial ischemia. A emergent cardiology consult can be helpful for equivocal cases.
Dr. Smith's ECG Blog
MARCH 22, 2024
The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible. Back to the assessment of ischemia: Returning to the ECG, the leads that catch my eye first are -- I, II, V4, V5, V6. Ischemia can be disguised by a wide escape rhythm, which decreases the sensitivity of ECG.
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. GREAT case by Dr. McLaren!
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.
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. (
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 ).
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