Angina and Echocardiogram - Cardiovascular Update

Young man with chest pain and an abnormal echocardiogram

Heart BMJ

APRIL 15, 2024

The patient was referred for an exercise nuclear study and did 11 min on the Bruce protocol without angina or ischaemic ECG changes. A transthoracic echocardiogram was performed ( figure 1 ). Figure 1 Transthoracic echocardiogram ((A) apical four-chamber view; (B) parasternal short-axis view).

Chest Pain

Chest Pain Echocardiogram Angina Laboratory

Abstract 4144084: Enhanced External Counterpulsation as a Novel Treatment for Heart Transplant Candidates with Ischemic Heart Failure with Reduced Ejection Fraction

Circulation

NOVEMBER 11, 2024

It is primarily indicated for refractory angina that is not amenable to PCI or CABG with the opinion of a cardiologist. Despite being a heart transplantation candidate, she declined revascularization and sought alternative treatments for angina, dyspnea, and daily activity limitations.

Heart Transplant

Heart Transplant Transplant Angina Heart Failure

A man in his 40s with 3 days of stuttering chest pain

Dr. Smith's ECG Blog

MARCH 13, 2024

Nossen also pointed out that with voltage this high in the limb leads, you would typically expect some degree of inferior/inferolateral ST depression (the so-called "LVH strain" pattern), and in fact this patient did have severe LVH on subsequent echocardiogram (which Dr. Nossen did not know at the time). The troponin peaked at 25749 ng/L.

Chest Pain

Chest Pain Angina Echocardiogram Myocardial Infarction

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

Sigmoid ventricular septum treated with endocardial ablation to improve left ventricular outflow: cases report

Frontiers in Cardiovascular Medicine

OCTOBER 7, 2024

Patients experiencing LVOTO may manifest symptoms such as angina, syncope, etc. Our report describes two cases of SVS treated with endocardial ablation to improve LVOTO.Case reportCase 1: A 74-year-old female patient with angina and syncope was admitted to the hospital and diagnosed with SVS by transthoracic echocardiogram.

Ablation

Ablation Angina Chest Pain Echocardiogram

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque

Plaque Angina Blog Stents

Critical Left Main

EMS 12-Lead

JULY 24, 2023

Given the consistency of the clinical profile with typical angina, associated risk factors, and abnormal ECG findings, a cardiology consult was promptly requested. 3-vessel disease with a culprit lesion [Typical angina, multiple risk factors] b. If they all return normal, then this is unstable angina. Anemia [Normal Hgb] g.

Angina

Angina Ischemia Coronary Angiogram Stenosis

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

MARCH 9, 2013

For those who depend on echocardiogram to confirm the ECG findings of ischemia, this should be sobering. When there is extremely brief ischemia, as in this case , or this case , it may entirely reverse, especially in unstable angina (negative troponins). The peak troponin I was 0.364 ng/ml. Lessons: 1. de Zwaan C., Janssen J.H.A.,

Chest Pain

Chest Pain Myocardial Infarction Ischemia Angina

Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization

Circulation

NOVEMBER 11, 2024

Patients with dextrocardia present a diagnostic challenge, particularly in the context of acute coronary syndrome.Case Presentation:A 49-year-old male with a medical history of dextrocardia, hypothyroidism, dyslipidemia and hypertension was referred to a cardiologist by his primary physician due to a 3-week history of unstable angina.

Coronary Artery Disease

Coronary Artery Disease Angioplasty Anatomy Angina

Abstract 4140337: Resting Heart Rate and Chronotropic Incompetence are Linked

Circulation

NOVEMBER 11, 2024

The relationship between low RHR and CI has yet to be described.Purpose:We hypothesize that resting sinus bradycardia (low RHR) could be a predictor of chronotropic incompetence and reduced exercise capacity.Methods:The derivation cohort consists of 201 patients with normal Bruce protocol treadmill stress echocardiogram.

Exercise

Exercise Chest Pain Myocardial Infarction Bradycardia

Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

As hours go by, these T inversions always evolve , [unless 1) there is re-occlusion, in which case they go upright and become hyperacute, with or without additional ST elevation, ("pseudonormalize") or 2) no infarction at all (negative troponin, true unstable angina with dynamic T-waves, in which they may normalize). Gottlieb SO, et al.

Chest Pain

Chest Pain Thrombosis Myocardial Infarction STEMI

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

Dr. Smith's ECG Blog

JUNE 18, 2011

When flow is restored, wall motion may completely recover so that echocardiogram does not detect the previous ischemia. Transient ST elevation is very hazardous. Even when the serial troponins are negative, the ECG is critical to the diagnosis of ACS. This is not pericarditis because: a.

STEMI

STEMI Pericarditis Hospital Aneurysm

Precordial ST depression. What is the diagnosis?

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

STEMI Ischemia Chest Pain Myocardial Infarction

Hypertrophic Cardiomyopathy

All About Cardiovascular System and Disorders

APRIL 30, 2024

Angina is another common symptom due the hypertrophy which causes a coronary supply demand mismatch Symptoms of HCM include syncope/near syncope, which could be precipitated by exertion, hypovolemia, rapid standing, Valsalva manoeuvre, diuretics, vasodilators or arrhythmia.

Cardiomyopathy

Cardiomyopathy Bicuspid/Mitral Document Arrhythmia

What does this ECG with significant ST Elevation represent?

Dr. Smith's ECG Blog

JULY 21, 2019

Get an emergent contrast echocardiogram. OMI is generally of more acute onset, unless there is intermittent angina. QTc's were 330 ms and 373 ms This is what I texted back: These look like they are a very pronounced case of Benign T-wave Inversion. I do not think this is acute occlusion myocardial infarction (OMI). huge R-wave in V4 3.

Chest Pain

Chest Pain Myocardial Infarction Pericarditis Angina

The three things that can go wrong with the heart

Dr. Sanjay Gupta

DECEMBER 19, 2022

With this test, an echocardiogram is done at rest to study the pumping ability of the heart. Firstly the plaque may continue to build up and cause actually restrict blood from getting to the heart muscle and this often presents with symptoms of chest tightness on exertion or angina.

Heart Rhythm

Heart Rhythm Plaque Heart Attack Heart attacks

Watch what happens when "pericarditis" and morphine cloud your judgment

Dr. Smith's ECG Blog

JULY 3, 2018

No further echocardiograms were available after cath. This transient occlusion can happen repeatedly without even making a troponin if the episodes are brief enough, and this type of stuttering event is what used to be the meaning of the term unstable angina.

Pericarditis

Pericarditis Chest Pain Stents Stent

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Takotsubo is a sudden event, not one with crescendo angina. Here is the cath report: Echocardiogram: There is severe hypokinesis of entire LV apex and apical segment of all the walls. An apical OMI has the same ultrasound findings as takotsubo, and thus mimics takotsubo. Learning Points: 1. Learn to Recognize Hyperacute T-waves 2.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Syncope and Prehospital Cath Lab activation -- What do you think?

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

Next day, a stress echo was done: The exercise stress echocardiogram is normal. The patient did not report angina with stress. No wall motion abnormality at rest. No wall motion abnormality with stress. The stress electrocardiogram is non-diagnostic.

Chest Pain

Chest Pain Ischemia Angina Electrocardiogram

An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

JULY 31, 2018

These are reperfusion T-waves (the same thing as Wellens' waves) Echocardiogram Regional wall motion abnormality-distal septum and apex. Regional wall motion abnormality-distal inferior wall. ECG recorded at time 38 hours: A further evolutionary stage of T-wave inversion. Int J Cardiol. 2016;207:341–348. doi: 10.1016/j.ijcard.2016.01.188.

SCAD

SCAD Chest Pain Myocardial Infarction Ischemia

Are there hyperacute T-waves? And how can we know?

Dr. Smith's ECG Blog

DECEMBER 6, 2024

Case continued Troponins over 26 hours, from right to left : Echocardiogram: Mild concentric left ventricular wall thickening, normal cavity size, and normal systolic function. You can see here that only lead II had HATW (as indicated by the red) We still have a lot of refinement to do to improve this system.

Coronary Artery Bypass Graft

Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis

Normal ACS care, everything by the book! But normal ACS care could be much better. This post explains everything.

Dr. Smith's ECG Blog

MARCH 17, 2025

Echocardiogram showed inferior hypokinesis. Even though guidelines say that patients with high-risk features, refractory angina, instability, etc. As you can see, the lesion is not very angiographically impressive , more on this below. Troponin was rising when last checked, 8928 ng/L. This is the limitation of STEMI.

STEMI

STEMI Chest Pain Document Myocardial Infarction

Is it important to try to determine the culprit vessel based on ECG?

Dr. Smith's ECG Blog

JANUARY 5, 2025

Echocardiogram showed inferior wall hypokinesis. On Sunday, the patient complained of dyspnea and angina while ambulating. (What does refractory mean if not days of unresolved chest pain which persists after starting medical therapy?) Initial hsTnI was 14,114 ng/L, repeat 12,651 ng/L, none further checked. Repeat ECG is shown.

Chest Pain

Chest Pain Ischemia Angina Echocardiogram

Young man with chest pain and an abnormal echocardiogram

Abstract 4144084: Enhanced External Counterpulsation as a Novel Treatment for Heart Transplant Candidates with Ischemic Heart Failure with Reduced Ejection Fraction

A man in his 40s with 3 days of stuttering chest pain

Webinars

Sigmoid ventricular septum treated with endocardial ablation to improve left ventricular outflow: cases report

Concerning EKG with a Non-obstructive angiogram. What happened?

Critical Left Main

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization

Abstract 4140337: Resting Heart Rate and Chronotropic Incompetence are Linked

Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome

Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 ng/ml)

Precordial ST depression. What is the diagnosis?

Hypertrophic Cardiomyopathy

What does this ECG with significant ST Elevation represent?

The three things that can go wrong with the heart

Watch what happens when "pericarditis" and morphine cloud your judgment

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Syncope and Prehospital Cath Lab activation -- What do you think?

An athletic 30-something woman with acute substernal chest pressure

Are there hyperacute T-waves? And how can we know?

Normal ACS care, everything by the book! But normal ACS care could be much better. This post explains everything.

Is it important to try to determine the culprit vessel based on ECG?

Stay Connected