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.

Ischemia 52

Ischemia STEMI Stenosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

JUNE 28, 2019

The cath lab was activated: Result: Thrombotic 95% stenosis at the ostium of a small LPL2 with 70% stenosis at the LPL2/LPDA bifurcation in the distal/AV groove Cx Tubular 70% stenosis in the mid-circumflex. (In More likely, these T waves probably reflect ischemia of uncertain age. It was stented. Learning Points: 1.

Chest Pain 52

Chest Pain Pericarditis Stents Stent 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

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

AUGUST 28, 2020

This is ischemia until proven otherwise. Here I annotate it: This shows 100% occluded circumflex (red arrow) and a 90% stenosis of the LAD (Yellow arrow). The LAD was thought to be not thrombotic, but a chronic tight stenosis. I learned that the patient is on Sotalol for control of PVCs. This explains the long QT.

Cardiogenic Shock 52

Cardiogenic Shock Chest Pain Ischemia Stenosis 52

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 52

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 52