Dr. Smith's ECG Blog

NOVEMBER 17, 2023

It is of an elderly woman who complained of shortness of breath and had a recent stent placed. LV aneurysm has QS-waves, so this couldn't be LV aneurysm, right? RBBB makes it mandatory that there are R'-waves even in the presence of LV aneurysm. Also, we know the patient had a stent. What do you think?

Aneurysm 116

Aneurysm Stent Stents Chest Pain 116

Stroke Journal

FEBRUARY 1, 2024

Background and Purpose:The flow diverter (FD) has dramatically improved the treatment outcome of large / giant internal carotid artery (IC) aneurysms. Stroke, Volume 55, Issue Suppl_1 , Page ATP151-ATP151, February 1, 2024. However, it is difficult to predict the treatment outcome of FD just after the treatment.

Aneurysm 40

Aneurysm Outcomes Stents Stent 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

years) underwent surgery for unruptured anterior communicating artery aneurysms in our hospital between January 2018 and January 2023.ResultsThe ResultsThe mean aneurysm dome size was 5.29 mm (2–22 mm), and the mean aneurysm neck size was 3.2 12; ATLAS, 14). Follow‐up was performed in 55 patients, averaging 29.5

Aneurysm 40

Aneurysm Embolism Stent Stents 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionBasilar‐tip aneurysm (BTA) is the most common aneurysm found in the posterior circulation, representing 5–8% of total intracranial aneurysms. For ruptured aneurysms, Adjuvant therapy (BAC or SAC) was used to treat larger dimension aneurysms compared to CE (p = 0.046). vs. 10.7%).

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Aneurysm Stent Stents ICU 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionIntracranial aneurysms, both ruptured and unruptured, pose a significant risk to the general population. Cases of unruptured intracranial aneurysms (UIA) are estimated to affect roughly 3% of the general population and aneurysmal subarachnoid hemorrhage (aSAH) have an incidence of 8 to 9 people per 100,000.

Aneurysm 40

Aneurysm Embolism Stent Stents 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionFlow diverters (FD) are stent‐type devices that enable the exclusion of intracranial aneurysms in clinical scenarios where coil‐type devices exhibit high failure rates. Adults older than 18 with non‐ruptured intracranial aneurysms were included. years (±13.3). years (±13.3).

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Aneurysm Embolism Angioplasty Stent 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Ruptured aneurysmal subarachnoid hemorrhage accounted for 15.7% (8/51) of all patients. The most common aneurysm location in the present study was MCA bifurcation (52.9%). The median maximal aneurysm diameter was 6.9mm, while the median neck size was 4.4mm. Retreatment was required in 1 aneurysm.

Aneurysm 40

Aneurysm Embolism Hemorrhage Document 40

Heart BMJ

AUGUST 14, 2024

Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.

Aneurysm 52

Aneurysm Chest Pain Myocardial Infarction Thrombosis 52

Dr. Smith's ECG Blog

JANUARY 31, 2020

Although diagnostic of MI, it is highly suspicious for " Old inferior MI with persistent ST Elevation" or "inferior aneurysm morphology" because of the well-formed Q-waves and the flat T-waves. To repeat: in contrast, anterior aneurysm is much more easily distinguished from acute MI due to the QS-waves.

Angina 52

Angina Stents Stent Aneurysm 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionFlow diversion (FD) is commonly used for the treatment of aneurysms involving the ophthalmic segment of the carotid artery (COA). The origin of the ophthalmic artery (OA) in relation to the aneurysm sac can affect recurrence and complications. directly from the aneurysm fundus, B. aneurysm neck, C.

Aneurysm 40

Aneurysm Outcomes Embolism Stent 40

Stroke: Vascular and Interventional Neurology

FEBRUARY 15, 2024

BACKGROUNDThe optimal endovascular approach for acutely ruptured wide‐neck intracranial aneurysms remains uncertain, and the use of stent‐assisted coiling or flow diversion is controversial due to antiplatelet therapy requirements and potential risks. Stroke: Vascular and Interventional Neurology, Ahead of Print. versus BAC: 2.8%;P=

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Aneurysm Outcomes Hemorrhage Stent 40

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

There are QS-waves in V1-V3 suggesting old anterior MI with persistent ST Elevation (LV aneurysm morphology), but I have written a couple papers showing that in LV aneurysm, the T-wave is not > 0.36 T/QRS Amplitude Best Distinguishes Acute Anterior MI from Anterior Left Ventricular Aneurysm. LV Aneurysm vs New Infarction?

Chest Pain 108

Chest Pain Aneurysm Stent Stents 108

Stroke Journal

FEBRUARY 1, 2024

Introduction:The management of wide-necked internal carotid artery (ICA) aneurysms is technically challenging with established endovascular and microsurgical techniques that are limited by the associated morbidity and/or recurrence. Median aneurysm and neck size were 5.8 mm (IQR: 4.0-7.5) At a median 10.1 months (IQR: 6.3-12.6),

Aneurysm 40

Aneurysm Stenosis Academic Stent 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).

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Aneurysm Outcomes Hemorrhage Stent 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

5 ICSS‐ MRI study (International Carotid Stenting Study Magnetic Resonance Imaging Study), indicated that patients with periprocedural hemodynamic depression had decreased cerebral blood flow and increased the risk of new lesions in imaging.6 This is secondary to delayed postoperative cerebral ischemia and infarction caused by vasospasm.7

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Aneurysm Strokes Stroke Ischemia 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionIndications for flow diversion for the treatment of cerebral aneurysms have increased remarkably in recent years.1 1 This has been particularly useful for aneurysms that are difficult to treat via endosaccular or open approaches, such as pseudoaneurysms.2

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Embolism Aneurysm Hemorrhage Stent 40

Dr. Smith's ECG Blog

APRIL 12, 2013

A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. So it would be wise to look at the pre-discharge ECG, which was available: There are Q-waves and ST elevation on this pre-discharge (post-stent) ECG. He had no chest pain.

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STEMI Pulmonary Stents Stent 52

Frontiers in Cardiovascular Medicine

NOVEMBER 21, 2024

There were no surgery-related deaths, no paraplegia,and all patients were successfully discharged.

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Aortic Thrombosis Aneurysm Stent 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

Old ‘NSTEMI’ A history of coronary artery disease and a stent to the same territory further increases pre-test likelihood of acute coronary occlusion, including in-stent thrombosis. The patient had a history of ‘NSTEMI’ a decade prior, with an RCA stent. Does this change your interpretation?

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Chest Pain STEMI Aneurysm Stent 104

All About Cardiovascular System and Disorders

FEBRUARY 17, 2024

It can provide intraluminal fly-through and clipping-plane views which help endovascular assessment of stents, aneurysms, vessel wall irregularities and calcification. The dataset could even be used to generate 3D-printed models of congenital heart disease [2]. Reference Kang SL, Armstrong A, Krings G, Benson L.

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Congenital Heart Disease Congenital Aneurysm Heart Disease 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

The report describes heavy plaque in the proximal RCA by IVUS, but no lesions in the previously occluded RPL branch and no stent was deployed. It is consistent with an inferior LV aneurysm. Her ECG afterward is shown below: ECG from five days prior Smith : this shows an old inferior MI with persistent ST elevation.

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Chest Pain Hospital Anatomy Aneurysm 62

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Studies reporting results of patients who underwent diagnostic angiograms, endovascular management of acute stroke, aneurysm repair, and carotid or vertebral stenting were included. Randomized clinical trials (RCT) and observational studies that compared TRA and TFA were included.

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Aneurysm Stent Stents Outcomes 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

This unique case highlights the diagnostic and therapeutic challenges of a patient with multiple vascular risk factors who suffered from strokes secondary to BHS.MethodsA 79‐year‐old man with a past medical history of peripheral artery disease, abdominal aortic aneurysm, myocardial infarction with drug eluding stents (on dual antiplatelet therapy (DAPT)), (..)

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Stenosis Peripheral Arterial Disease Pacemaker Atherosclerosis 40

Dr. Smith's ECG Blog

JANUARY 28, 2023

hours after that first diagnostic ECG) : Mid-LAD culprit lesion, 99% stenosis, no pre-intervention TIMI flow available, but described as "severe subtotal lesion", which was stented with reported TIMI 3 flow resulting. Another lesion in the proximal LAD with 80% stenosis was stented as well. Culprit lesion was reduced to 0% and stented.

STEMI 52

STEMI Chest Pain Stent Stents 52

Dr. Smith's ECG Blog

OCTOBER 27, 2024

No thoracic aortic hematoma, aneurysm or dissection. First obtuse marginal also had an 80% stenosis and was stented. Patient states pain improved on ambulance ride over after receiving 325 mg Aspirin and nitroglycerin, with pain down to 2/10. CT Angio Chest IMPRESSION 1. No pulmonary embolism is identified.

STEMI 118

STEMI Chest Pain Myocardial Infarction Aneurysm 118

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.

Chest Pain 52

Chest Pain Aneurysm STEMI Document 52

Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. The EKG is diagnostic of acute inferior, posterior, and lateral OMI superimposed on “LV aneurysm” morphology. It was stented. He wrote most of it and I (Smith) edited.

Chest Pain 109

Chest Pain STEMI Echocardiogram Stent 109

Dr. Smith's ECG Blog

JULY 11, 2024

All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. The LV aneurysm morphology persists. Here, the mid LAD (blue arrow) and the ostial first diagonal (green arrow) stenoses are better visualized. This is the RAO caudal projection.

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Outcomes Stenosis Outpatient Echocardiogram 92

Dr. Smith's ECG Blog

JANUARY 16, 2020

Also a h/o LV aneurysm with thrombus, on anticoagulation, as well as a dual chamber pacemaker. It was opened and stented with resulting TIMI-3 (normal) flow. The stent to LCX is patent. Aneurysm of the mid-portion of the lateral and inferolateral wall. They called 911. On arrival, the BP was 60/30.

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Aneurysm Heart Disease Stent Stents 52

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

It was opened and stented. 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. LV aneurysm puts them at risk for a mural thrombus, which puts them at risk for embolism, especially embolic stroke.

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Aneurysm Ischemia Embolism STEMI 52

DAIC

JUNE 17, 2024

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are minimally invasive procedures to treat abdominal, and many thoracic, aortic aneurysms. An aneurysm, an abnormal bulge or ballooning in the wall of a blood vessel, can burst which causes bleeding inside the body and often leads to death. [1]

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Aortic Aneurysm Anatomy Vascular Care 105

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. 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." This is a very common misread. What do you think?

STEMI 52

STEMI Chest Pain Cardiac Arrest Stent 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. An open 90% LAD was stented. This 42 yo diabetic male presented with cough and foot pain. The LAD has reperfused early.

STEMI 52

STEMI Myocardial Infarction Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

A CT was completed to rule out dissection, PE, or aneurysm, and this was unremarkable. A single DES stent was placed, and the patient did well post-procedure. Clin Cardiol 2022; [link] Labs included: hsTnI 156 ng/L, Hb 12 g/dL, WBC 12x10^9/L, Cr. mg/dL, K 3.5 The patient’s abdomen was benign and no gross blood on rectal exam.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. These are all findings that can be expected with left ventricular aneurysm. She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. The last echocardiography 12 months ago showed HFmrEF. There is some STE.

Tachycardia 101

Tachycardia Electrophysiology Atrial Flutter Ischemia 101

Dr. Smith's ECG Blog

JULY 19, 2019

STE occurs primarily in viable ischemic myocardium; persistent STE after completed infarction is ominous and portends development of an aneurysm. Thrombectomy performed, then stent placed with improvement of TIMI 0 to TIMI 3 flow. The cath lab was now activated. He was found to have 100% mid LAD occlusion. Our THANKS to Drs.

Chest Pain 52

Chest Pain STEMI Aneurysm Pericarditis 52

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

It was stented. == MY Comment by K EN G RAUER, MD ( 9/27/2019 ): == As suggested by the title of this Blog post — confirmation of the diagnosis in this case was made not by ECG — but instead by chest aorta CT ! Once dissecting aneurysm was ruled out by chest aorta CT — the possibility of acute ischemic heart disease becomes paramount.

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Chest Pain Blog Ischemia Article 52