Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 18, 2024

Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1] Circulation 2014 2. 1] European guidelines add "regardless of biomarkers". But only 6.4% link] References 1. Amsterdam et al.

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Angiography usually reveals an absence of collateral circulation to the infarct zone. It commonly occurs in the setting of a first myocardial infarction (MI) in the background of delayed or absent reperfusion therapy.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

JULY 31, 2018

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point. Circulation. Again, cath lab was not activated. What does this troponin level mean?

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Takotsubo is a sudden event, not one with crescendo angina. 9 This dissociation between the degree of stenosis and the propensity to provoke an acute coronary syndrome helps to explain why myocardial infarction often occurs without being heralded by the demand-induced symptoms of angina that would result from a high-grade stenosis.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

MIBHS

OCTOBER 15, 2024

This is where coronary circulation comes into play. Coronary circulation refers to the movement of blood through the network of coronary arteries and veins that supply the heart muscle (myocardium) itself. Step-by-Step Breakdown of Coronary Circulation 1.

Circulation 52

Circulation Heart attacks Heart Attack Chest Pain 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

The patient was given aspirin, heparin, morphine, and ondansetron and and transferred to a PCI-capable facility for a diagnosis of "unstable angina" with dynamic ECG changes. Possible mechanisms of ventricular arrhythmias elicited by ischemia followed by reperfusion. Circulation Research , 56 (2), 184–194. Moffat, M. Washam, J.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

DAIC

JANUARY 23, 2024

Inflammation driven by signaling cytokines, circulating immune cells, adhesion molecules, and oxidized low-density lipoprotein cholesterol (LDL-C) leads to atherosclerotic plaque development, plaque progression, and eventual rupture.14,15 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. Circulation.

Cardiovascular Disease 111

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease 111

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4146032-A4146032, November 12, 2024. Background:Stress testing is a well-established non-invasive method commonly used in clinical practice for patients with angina. 12.8%; p<0.01; (figure 1A), ischemia was found in 36.5% (95% CI; range 28.7-44.3%; years and 75% were male.

Diabetes 40

Diabetes Myocardial Infarction Ischemia Angina 40

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 11, 2016

A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. Circulation 1993; 88:896-904. Methods: Oliva et al. (94)

Myocardial Infarction 52

Myocardial Infarction Pericarditis STEMI Angina 52

Dr. Smith's ECG Blog

MARCH 25, 2025

There is low voltage in the precordium which always makes reading ischemia harder. In ACS, chest pain is the warning sign of ongoing ischemia. Smith : As Willy says, and as we've said many times before, morphine will resolve pain without resolving ischemia. ECG 1 What do you think? To me, this ECG is not diagnostic.

Chest Pain 63

Chest Pain Ischemia Plaque Stents 63

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Denying patients the potential benefit of revascularization just because their symptoms have lasted a certain amount of time shows poor understanding of the pathophysiology of myocardial ischemia. 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