Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

This confirms that the pain was ischemia and is now resovled. The cardiology fellow agreed with plan for emergent cath and escorted the patient to the cath lab. Another ECG was recorded after the nitroglycerine and now without pain: All findings are resolved. The i nitial hs troponin I returned 75%.

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Ischemia Plaque Stenosis Myocardial Infarction 122

Cardiology Update

NOVEMBER 19, 2023

The ORBITA-2 trial ( NCT03742050 ) investigated the efficacy of Percutaneous Coronary Intervention (PCI) compared to placebo in 301 patients with stable angina. Results revealed ischemia in one cardiac territory in 80% of patients, two territories in 17%, and three territories in 2%. compared to the placebo group (5.6; N Engl J Med.

Angina 52

Angina Ischemia Article Research 52

Frontiers in Cardiovascular Medicine

MARCH 17, 2024

Background Refractory angina (RA) is a chronic condition characterized by the presence of debilitating angina symptoms due to established reversible ischemia in the presence of obstructive coronary artery disease (CAD).

Angina 64

Angina Quality of Life Coronary Artery Disease Ischemia 64

American College of Cardiology

APRIL 8, 2024

The goal of the ORBITA-COSMIC trial was to determine the effects of a coronary sinus reducer (CSR) device versus sham control on both myocardial blood flow (MBF) assessed by stress perfusion cardiac magnetic resonance imaging (CMR) and daily angina burden in patients with refractory angina.

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Ischemia Angina Article 58

Dr. S. Venkatesan MD

SEPTEMBER 23, 2024

After a series of experiments in animals and peripheral vessels, he proved with a single patient N-1 study that effectively treated refractory LAD angina in a 38-year-old man in 1977. No one has questioned the efficacy of PCI for true angina with a critical lesion. Within a span of five to ten years, the concept spread globally.

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Angina Academic Stenosis Article 52

The New England Journal of Medicine

NOVEMBER 10, 2023

In a randomized trial of PCI in patients with stable angina who were receiving little or no antianginal medication and had documented ischemia, PCI resulted in a better health status with respect to angina than placebo at 12 weeks.

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Angina Document Ischemia 40

Dr. Smith's ECG Blog

MAY 20, 2024

This EKG is diagnostic of transmural ischemia of the inferior wall. If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. Transmural ischemia (as seen with the OMI findings on ECG) is not very common with demand ischemia, but is possible.

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Chest Pain Blood Pressure Ischemia STEMI 126

Circulation: Cardiovascular Quality & Outcomes

FEBRUARY 26, 2025

The benefit of an invasive strategy on Seattle Angina Questionnaire angina frequency scores was reduced for asymptomatic patients (odds ratio [95% credible interval], 1.16 [0.661.71] versus 2.26 [1.752.80]), as well as for those on no antianginal medications. Diabetes was present in 28% and multivessel disease in 51%.

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Ischemia Heart Disease Angina Anatomy 40

Dr. Smith's ECG Blog

MARCH 13, 2024

It is not clear exactly what symptoms the patient may have been experiencing at this time, but the notes indicate that he then developed "worsening" pain, suggesting he had likely had ongoing angina the whole time. Recall that medically refractory angina is itself a Class I indication for immediate angiography (see Figure 8). (It

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Chest Pain Angina Echocardiogram Myocardial Infarction 108

Circulation: Cardiovascular Interventions

NOVEMBER 6, 2023

We sought to determine the substrates for ischemia in patients with angina, nonobstructive coronary arteries (ANOCA) and a MB in the left anterior descending artery.Methods:Patients with ANOCA underwent acquisition of intracoronary pressure and flow during rest, supine bicycle exercise and adenosine infusion.

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Ischemia Exercise Angina Cardiovascular Interventions 40

Dr. Smith's ECG Blog

MARCH 17, 2024

Although radiation into the left arm is most classic for coronary ischemia, radiation into both arms is actually modestly more predictive ). The primary care physician's note indicates low suspicion for cardiac ischemia, but "for completion, check troponin and ECG." Vasospastic angina is commonly the worst in the morning and at night.

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Angina Chest Pain Blog Ischemia 71

Heart BMJ

OCTOBER 28, 2024

1 Indeed, if the recently published ORBITA-2 trial demonstrated the benefit of revascularisation in relieving angina symptoms, 2 many other trials aiming to show a benefit on hard outcomes have failed in their purpose. 3 The ISCHEMIA-EXTEND reported the extended follow-up of the recent ISCHEMIA trial.

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Coronary Artery Bypass Graft Angioplasty Ischemia Angina 52

DAIC

MAY 14, 2024

The impact of this narrowing can ultimately result in angina (chest pain), which has been shown to double the risk of major cardiovascular events,1 as well as myocardial infarction ( heart attack ) or even death. Use Heart to Act on Angina. For more information: www.gehealthcare.com References: 1 World Health Federation.

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Coronary Artery Disease Interventional Cardiology Innovation Physiology 111

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. It should be known that each category can easily manifest the generic subendocardial ischemia pattern. What’s interesting is that the ECG can only detect ischemia.

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Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Paddy Barrett

DECEMBER 5, 2023

Whether stenting a narrowed coronary artery improves symptoms such as chest pain (angina) or shortness of breath is a very different question. Share Angina The classic definition of angina involves the sensation of tightness in the centre of the chest that is brought on with exertion and is relieved with rest. The result?

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Stents Stent Angina Heart Attack 59

Frontiers in Cardiovascular Medicine

FEBRUARY 18, 2025

ObjectiveA significant proportion (85%) of low-risk non-ST-elevation acute coronary syndrome (NSTE-ACS) patients do not receive objective confirmation of ischemia by stress echocardiography (SE), yet remain a healthcare burden due to lower long-term survival and overuse of medical services.

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Chest Pain Exercise Angina Coronary Artery Disease 52

Dr. Smith's ECG Blog

DECEMBER 14, 2018

This appears to be a classic Wellens' ECG, Pattern A, with terminal T-wave inversion in V2-V4, preserved R-waves, and it appears to be Wellens' syndrome, as it occurred after resolution of typical angina pain. When this happens, troponins are negative, there is no wall motion abnormality, and it is true unstable angina.

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Chest Pain Angina Ischemia Stenosis 52

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. In this case, the duration of ischemia was so brief that there was no such evolution, and there was near-normalization. Ischemia may be so brief that Wellens' waves do not evolve 3. The peak troponin I was 0.364 ng/ml.

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Chest Pain Myocardial Infarction Ischemia Angina 52

Dr. Smith's ECG Blog

MARCH 9, 2017

Smith comment: T-wave inversion such as seen in the first ECG can be seen with active non-transmural ischemia. But in this case, it is due to active ischemia, resolves with resolution of ischemia, and has little if any troponin elevation. Unstable Angina still exists. Thus, unstable angina exists and can be deadly.

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Chest Pain Angina Ischemia Plaque 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. You can see in the lead-specific analysis that she "sees" the STD in V5, V5, and II, with STE in aVR as signs of "Not OMI", because subendocardial ischemia pattern is not the same as OMI. In my opinion, I think it looks more like subendocardial ischemia. As per Drs.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

DECEMBER 7, 2023

This proves effective treatment of the recurrent ischemia. The patient had no further symptoms of ischemia. Serial EKG is very high yield diagnostic test in patients with stuttering angina. EKG 3 is diagnostic for developing re-occlusion, and EKG 4 proves that the nitrates relieved the ischemia. =

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SCAD Ischemia Coronary Artery Disease Cardiomyopathy 124

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

The ECG in the chart was read as "no obvious ST changes," (even though no previous ECG was available) and the formal read by the emergency physicians was: "ST deviation and moderated T-wave abnormality, consider lateral ischemia." When the ischemia is resolved, the wall motion may completely recover, or there may be persistent stunning.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

Circulation

NOVEMBER 11, 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%; Circulation, Volume 150, Issue Suppl_1 , Page A4146032-A4146032, November 12, 2024. Follow-up ranged from 1 to 5.2

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Diabetes Myocardial Infarction Ischemia Angina 40

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.

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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] 1] European guidelines add "regardless of biomarkers". But only 6.4%

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STEMI Chest Pain Myocardial Infarction Blog 121

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was clearly severe subepicardial ischemia causing ST Elevation, but it was not of a long enough duration to result in measurable infarct. Therefore this is " Transient ST Elevation Unstable Angina." As there was ruptured plaque, this is NOT Prinzmetal's angina. You can see the deficiency of the definition of MI.

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STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

APRIL 22, 2022

We are told that the Stress Echo that was performed showed objective evidence of inducible ischemia ( confirmed apparently by both wall motion abnormalities and ECG changes ). Was this objective evidence of inducible ischemia accompanied by chest pain? Was this objective evidence of inducible ischemia accompanied by chest pain?

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Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

APRIL 23, 2016

Some persistently denied that the T-wave in V2 was a specific sign of ischemia. 2 or 3 do not rule out unstable angina, even in the era of high sensitivity troponin: this study by Thelin et al. These are 10 cases of LAD occlusion with subtle Hyperacute T-waves in lead V2 (or V3) only. Steps to verify LAD occlusion, or exclude it: 1.

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Chest Pain STEMI Angina Ischemia 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. And is there new left bundle branch block (LBBB)? Moffat, M.

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Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Because previous ischemia induces myocardial preconditioning, decreasing the likelihood of transmural myocardial necrosis and myocardial rupture, patients with evidence of diabetes mellitus, chronic angina or previous MI are less likely to experience a rupture.

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Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

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

MIBHS

OCTOBER 15, 2024

For example, if a coronary artery becomes blocked due to plaque buildup (a condition known as coronary artery disease), the heart muscle may not receive enough oxygen, leading to chest pain (angina) or, in more severe cases, a heart attack. CAD is one of the leading causes of heart attacks.

Circulation 52

Circulation Heart Attack Heart attacks Chest Pain 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. So what will you do for this patient? They found an acute, total, thrombotic occlusion of the proximal LAD. They opened it. Patel et al.,

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STEMI Chest Pain Ischemia Myocardial Infarction 52

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.

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Aortic valve Myocardial Infarction Aortic Blood Pressure 103

All About Cardiovascular System and Disorders

APRIL 13, 2024

ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due to transmural ischemia of the basal part of the septum. This patient had reported with recent onset angina. Injury current of basal part of septum is directed towards right shoulder and aVR. ST elevation was 2 mm in aVR and 1 mm in V1.

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Stenosis Coronary Artery Bypass Graft Coronary Artery Disease Document 52

Dr. Anish Koka

MAY 16, 2023

Typical angina was defined as a symptom complex that includes substernal chest pressure or pain that was made worse with exertion/emotional stress, and relieved by rest or nitroglycerin. Atypical angina is classified as having any two of the three symptoms, and non-anginal pain any one of the three symptoms. This happens. But its rare!

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Ken Grauer, MD

JULY 15, 2023

Additional Teaching Points: Type-2 MI ( M yocardial I nfarction ) — is defined by an increase in troponin with evidence of ischemia that is not due acute coronary disease, but which instead results from a mismatch in oxygen supply and demand ( Smilowitz et al — Coron Artery Dis 29(1):46-52, 2018 ).

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Blog Coronary Angiogram Cardiomyopathy Ischemia 78