Stroke Journal

FEBRUARY 1, 2024

Introduction:Delayed cerebral ischemia (DCI) is a leading cause of morbidity and mortality in aneurysmal subarachnoid hemorrhage (aSAH). There was no significant difference between the two arms with regards to admission characteristics, aneurysm location, treatment type, or total number of vasospasm treatments.

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Aneurysm Hemorrhage ICU Ischemia 40

Stroke Journal

FEBRUARY 1, 2024

In this study, our hypothesis was that NETs cause vascular occlusion leading to delayed cerebral ischemia (DCI) and worse outcome after SAH. Aneurysmal SAH patients who developed DCI had elevated markers of NETs compared to non-DCI patients. Similar findings were observed for PAD4 inhibition.

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Ischemia Hemorrhage Aneurysm Outcomes 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:Elevated levels of Interleukin-6 (IL-6) levels in cerebrospinal fluid (CSF) have been correlated with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Stroke, Volume 55, Issue Suppl_1 , Page AWP152-AWP152, February 1, 2024.

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Aneurysm Hemorrhage Ischemia Strokes 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionThe optimal endovascular approach for wide‐neck intracranial aneurysms (IAs) during the acute phase of bleeding remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks (1, 2).

Aneurysm 40

Aneurysm Outcomes Hemorrhage Stents 40

All About Cardiovascular System and Disorders

NOVEMBER 16, 2023

Mechanism is thought to be due to sustained sympathetic stimulation, probably caused by dysfunction of insular cortex resulting in reversible neurogenic damage to the myocardium which could include contraction bands and subendocardial ischemia [2]. Serial measurements of cardiac enzymes were normal in that case. 2009 Nov;40(11):3478-84.

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Hemorrhage Myocardial Infarction Aneurysm Electrocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

One very useful adjunct is ultrasound: Echo of his heart can distinguish aneurysm from acute MI by presence of diastolic dyskinesis, but it cannot distinguish demand ischemia from ACS. These must raise suspicion of old MI with persistent ST elevation. The patient was suffering from severe dehydration, possibly with sepsis.

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STEMI Cardiogenic Shock Tachycardia Aneurysm 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

However, old MI w/aneurysm morphology (persistent ST-Elevation) can look just like this. While this may be change that is reciprocal to an Acute/Subacute Inferior STEMI, the problem is that LV aneurysm may also manifest with this reciprocal change. Old MI w/Aneurysm will show moderate ST Elevation, as seen here.

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Chest Pain Aneurysm STEMI Hospital 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? These are all findings that can be expected with left ventricular aneurysm.

Tachycardia 111

Tachycardia Electrophysiology Atrial Flutter Ischemia 111

Stroke Journal

FEBRUARY 1, 2024

Subarachnoid hemorrhage (SAH), commonly caused by a ruptured aneurysm, carries a high rate of disability and death. Preclinical studies demonstrate SAH induces dysregulation of the cerebrovasculature and increases neuroinflammation, which contributes to early brain injury and delayed cerebral ischemia.

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Hemorrhage Ischemia Aneurysm Strokes 40

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

Normal RBBB, no evidence of ischemia. This may be permanent and may be associated with echocardiographic dyskinesis (aneurysm). LV aneurysm is common in completed, full thickness (transmural) MI, which is what we have here. Here is the patient's previous ECG (Figure 2): Previous ECG. R-waves of of normal height.

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Aneurysm Ischemia Embolism STEMI 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

All of this appears to be consistent with "No Reflow", or small vessel occlusion with persistent ischemia in spite of an open artery. This ECG is diagnostic of anterior LV aneurysm in the presence of RBBB. See more such cases of RBBB with LV aneurysm here. He was hospitalized for 16 days. ECG one month later: What do you think?

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Aneurysm Chest Pain Cardiogenic Shock Blog 71

Dr. Smith's ECG Blog

JUNE 18, 2011

The old ECG has a Q-wave with persistent ST elevation in lead III, and some reciprocal ST depression (typical for aneurysm morphology). This is "Persistent ST elevation after previous MI" or "LV aneurysm morphology". LV aneurysm is very different for inferior vs. anterior MI. This is not pericarditis because: a.

STEMI 52

STEMI Pericarditis Hospital Aneurysm 52

Stroke Journal

FEBRUARY 1, 2024

Methods:This was a retrospective observational study using data from the large multicenter international Stroke Thrombectomy and Aneurysm Registry (STAR). The primary outcome measure was successful recanalization defined as modified Thrombolysis in Cerebral Ischemia (mTICI) score of 2b or higher.

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Strokes Stroke Circulation Thrombolysis 40

Dr. Smith's ECG Blog

JULY 31, 2013

T-wave inversion in V2 is inconsistent with early repol, and is typical of posterior ischemia. In addition, there is ST depression, diagnostic of ischemia, in V3-V6. A coronary aneurysm was found. T-waves in inferior leads are hyperacute, out of proportion to those in early repol 5. mm of ST elevation in inferior leads.

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Chest Pain Aneurysm STEMI Ischemia 52

Stroke Journal

FEBRUARY 1, 2024

The aim of this study is to develop and validate a stroke prediction tool for outcome in MT for AIS patients with low ASPECTS using data from an ongoing international multicenter registry, the Stroke Thrombectomy and Aneurysm Registry (STAR).Methods:236 90-day mRS 0-3 was observed in 0% of patients with a score of 0 or 1, 6.3%

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Strokes Stroke Circulation Outcomes 40

Dr. Smith's ECG Blog

DECEMBER 3, 2024

His initial high sensitivity troponin I returned at 1300 ng/L and given that his cardiac workup was otherwise unremarkable, a CT was obtained to evaluate for pulmonary embolism and aortic aneurysm or dissection but this too was unrevealing. Another EKG was also obtained. ECG at time 82 minutes: What do you think?

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Catheterization Laboratory STEMI Ischemia Blog 106

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. A CT was completed to rule out dissection, PE, or aneurysm, and this was unremarkable. mg/dL, K 3.5 Another 162mg ASA and heparin were given at this point.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

Persistent ST elevation 3 days after a nearly transmural MI portends possible LV aneurysm. It is very unlikely to be LV aneurysm morphology when the ST elevation is so high and the T-Wave inversion is so deep. The patient continued to have ischemia after PCI, and in fact had an episode of polymorphic VT shortly after while in the ICU.

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STEMI Myocardial Infarction Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Finally, coronary angiography was performed (at least 5 days after presentation) which confirmed LAD aneurysm with large thrombus burden, TIMI 0 flow, thrombectomy performed. No further cath details available.

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Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

MARCH 11, 2019

The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI. ng/mL is seldom a result of demand ischemia (type 2 MI).

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Chest Pain Ischemia Aneurysm Myocardial Infarction 52

Dr. Smith's ECG Blog

MAY 18, 2023

My rule is that if any lead has a T/QRS ratio ＞0.36, then it is acute OMI; if ＜0.36, then either old MI (LV aneurysm) or subacute OMI. There is ST depression in V3 and V4. Always abnormal.

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Aneurysm Blog Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 29, 2015

However, the ST segments in patients with LVH may show significant variation over time in the absence of ischemia. 3 Some have also suggested that the typically asymmetric T wave inversion (TWI) of LVH might be distinguished from the typically symmetric TWI of cardiac ischemia. Is LVH like left ventricular aneurysm?

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STEMI Myocardial Infarction Chest Pain Aneurysm 40

Dr. Smith's ECG Blog

OCTOBER 15, 2024

The EKG is diagnostic of acute inferior, posterior, and lateral OMI superimposed on “LV aneurysm” morphology. Whether these EKGs show myocarditis, a normal variant, or something else, they are overall not typical of transmural ischemia of the anterior or high lateral walls. Patient 2 , EKG 1: What do you think?

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Chest Pain STEMI Echocardiogram Stents 117

Dr. Smith's ECG Blog

JANUARY 28, 2023

Prior ECG available on file from 2 months before: We do not know the clinical events happening during this ECG, but there is borderline tachycardia, PVCs, and likely some evidence of subendocardial ischemia with small STDs maximal in V5-6/II, slight reciprocal STE in aVR. QS waves from V2-V5 consistent with LV aneurysm morphology.

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STEMI Chest Pain Stents Stent 52

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

This transmural ischemia, but not necessarily completed infarction (yet). See more images of this case at Gopal's Spectral CT Blog: It's all about confidence With continued symptoms, an elevated troponin, and no other explanation, this is acute MI with ongoing ischemia until proven otherwise.

Chest Pain 52

Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was What do you think? Does he need a stress test? --Is

STEMI 40

STEMI Chest Pain Cardiac Arrest Stents 40

Dr. Smith's ECG Blog

APRIL 3, 2019

You might think it is "Old MI with persistent ST Elevation" (otherwise known as "LV aneurysm" morphology.") That is a reasonable thought, but we have shown that if there is one lead of V1-V4 with a T/QRS ratio greater than 0.36, then it is STEMI, not LV aneurysm. Pain will resolve with completed infarct or with resolution of ischemia.

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STEMI Ischemia Chest Pain Aneurysm 40

DAIC

JANUARY 23, 2024

1,2 ASCVD causes or contributes to conditions that include coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease (inclusive of aortic aneurysm).3 mg reduced the risk of cardiovascular death, MI or heart attack, ischemic stroke, or ischemia-driven coronary revascularization by 31% compared with placebo.34

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

MARCH 11, 2016

More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. During the 48 hours of angina, such reversible ischemia often leads to myocardial stunning with akinesis of the myocardial wall that puts it at risk for thrombus.

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Myocardial Infarction Pericarditis Angina STEMI 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

If you still have not read it, I strongly recommend that you read the following article on the diagnosis of "posterior" MI: Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia), by Meyers HP et al. J Am Heart Assoc. doi: 10.1161/JAHA.121.022866.

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Myocardial Infarction Chest Pain Blog Echocardiogram 40

EMS 12-Lead

APRIL 28, 2022

In most cases, rather, the culprit is gross ischemia due to myocardial infarction, cardiomyopathy, or advanced coronary artery disease. It was postulated that such an ECG feature is associated with advanced myocardial dysfunction, to include left ventricular aneurysm, as the cause of arrhythmia. [7]

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Tachycardia AFIB Arrhythmia Coronary Artery Bypass Graft 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Repeat ECG at 1624 (shortly before cath): QS waves now present in V2-V3, with slight STE, showing the pattern of left ventricular aneurysm morphology. Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia." Upon arrival to the PCI center, the repeat troponin returned at 13,962 ng/L.

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Chest Pain STEMI Document Ischemia 52

DAIC

FEBRUARY 7, 2024

Globus New Investigator Award in Stroke awardee, is a postdoctoral fellow at Barrow Aneurysm & AVM Research Center (BARRC) at the Barrow Neurological Institute in Phoenix. Raed Joundi, M.D., is the Vascular Cognitive Impairment Award recipient.

Strokes 105

Strokes Stroke Research Health Disparities 105

Dr. Smith's ECG Blog

APRIL 8, 2015

Look for Vascular Etiology -- think of these while doing H and P: --Bleeding: ruptured AAA, GI bleed, ruptured ectopic pregnancy, other spontaneous bleed such as mesenteric aneurysms. Evidence of acute ischemia (may be subtle) vii. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Ken Grauer, MD

DECEMBER 21, 2024

iv ) The findings in Figure-4 could reflect LV aneurysm. Radionuclide scan was negative for ischemia. This may account for the anterior ST elevation seen in today's case ( BLUE arrows in leads V1,V2,V3 ). The patient was markedly hypertensive in the ED but he did not have CP. Chest X-Ray was normal. Troponins were negative.

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Blog Aneurysm STEMI Ischemia 78