Stroke Journal

FEBRUARY 1, 2024

Introduction:Recent randomized control trials suggested that mechanical thrombectomy (MT) was associated with good functional outcomes after acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in patients presenting with low Alberta Stroke Program Early CT Score (ASPECTS) (defined as ASPECTS 2-5). with a score of 2, 17.7%

Stroke 40

Stroke Strokes Circulation Outcomes 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:Despite comparable outcomes for different frontline techniques in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), there are sparse data regarding if and when to switch techniques if the first pass is unsuccessful. 3.86, P = 0.002) and 90-day good clinical outcome (adjusted odds ratio 2.10, 95% CI: 1.15-3.85,

Circulation 40

Circulation Stroke Strokes Thrombolysis 40

Stroke Journal

JANUARY 30, 2025

Due to the rarity of iatrogenic CeAD, existing literature on management and outcomes is limited. Of the 32 patients, 9(28.1%) had dissection with diagnostic angiograms, 6(18.8%) endovascular thrombectomy, 15(46.9%) aneurysm treatment, and 2(6.3%) angioplasty with or without stenting.

Stents 40

Stents Stent Angioplasty Aneurysm 40

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. Thus, this ECG predicts poor myocardial perfusion and poor outcome. This ECG is diagnostic of anterior LV aneurysm in the presence of RBBB. See more such cases of RBBB with LV aneurysm here.

Aneurysm 66

Aneurysm Chest Pain Cardiogenic Shock Blog 66

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. And young women have worse outcomes than other groups with STEMI because of the tendency to say, "Nah, couldn't be!"

Chest Pain 52

Chest Pain Aneurysm STEMI Ischemia 52

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.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Full case details and outcomes are below. 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." Smith's response was: "OMI Mimic."

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Stroke Journal

JANUARY 30, 2025

Background:According to the 2023 guidelines for the management of patients with aneurysmal subarachnoid hemorrhages (SAH), early treatment of ruptured aneurysms reduces the risk of repeated bleeds and facilitates treatment of delayed cerebral ischemia. No differences were noted in the size or location of aneurysm.

Aneurysm 40

Aneurysm Hospital Outcomes Stroke 40

Journal of the American Heart Association

DECEMBER 29, 2023

BackgroundThe outcome of diffuse angiogram‐negative subarachnoid hemorrhage (dan‐SAH) compared with aneurysmal SAH (aSAH) remains unclear. Propensity score matching resulted in matching 65 patients with dan‐SAH to 260 patients with aSAH, and clinical outcomes were compared between the groups. versus 0%,P=0.027), death (11.2%

Hemorrhage 40

Hemorrhage Aneurysm Outcomes Ischemia 40

Journal of the American Heart Association

FEBRUARY 29, 2024

BackgroundDelayed cerebral ischemia represents a significant contributor to death and disability following aneurysmal subarachnoid hemorrhage. The lack of standardized experimental setups and outcome assessments, particularly regarding secondary vasospastic/ischemic events, may be partly responsible for the translational failure.

Ischemia 40

Ischemia Hemorrhage Blood Pressure Aneurysm 40

Stroke Journal

JANUARY 30, 2025

The factors that may affect neuropsychological outcomes after aSAH are not well characterized. Clinical variables, modified Rankin score (mRS) at discharge, hemorrhage volume, and the occurrence of vasospasm or new ischemia during hospitalization were collected. Patients underwent Montreal Cognitive Assessment (MoCA).

Hemorrhage 40

Hemorrhage Aneurysm Quality of Life Ischemia 40

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.

Hemorrhage 40

Hemorrhage Ischemia Aneurysm Stroke 40

Dr. Smith's ECG Blog

OCTOBER 20, 2013

This ECG is diagnostic of diffuse subendocardial ischemia. She went for a head CT and had a severe subarachnoid hemorrhage (SAH) due to ruptured aneurysm. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. Unfortunately, but not surprisingly, the patient died a neurologic death.

Cardiac Arrest 52

Cardiac Arrest STEMI Hemorrhage Hospital 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

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.

Myocardial Infarction 52

Myocardial Infarction Pericarditis STEMI Angina 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.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

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.

STEMI 40

STEMI Chest Pain Ischemia Aneurysm 40

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. Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Abnormal ECG – looks for cardiac syncope.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

MARCH 3, 2025

There are no Q-waves to suggest old inferior MI, or inferior aneurysm as the etiology of the ST Elevation. The patient was started on heparin for possible NSTEMI vs demand ischemia. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.) What "initiates" the aortic stenosis cascade?

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

When there are QS-waves, one should always think about LV aneurysm, but ST to QRS ratio and T-wave to QRS ratio are far too large and not compatible with left ventricular aneurysm. There were no other causes of dyspnea apparent and thus we can assume that myocardial ischemia started 6 days prior.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89