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.

Angina 71

Angina Chest Pain Blog Ischemia 71

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). Mechanical complications secondary to myocardial infarction are infrequent due to most patients receiving revascularization quite rapidly.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

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.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

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. AIVR is not always the result of significant pathology, but is classically associated with the reperfusion phase of acute myocardial infarction.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

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. Eur J Emerg Med.

Chest Pain 83

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

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% Clin Cardiol 2022 4. Herman, Meyers, Smith et al. McLaren and Smith.

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

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." Consequences of reocclusion after successful reperfusion therapy in acute myocardial infarction.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

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

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

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 Appearance of abnormal Q waves early in the course of acute myocardial infarction: implications for efficacy of thrombolytic therapy. hours when she called 911. These do NOT indicate late, subacute MI. Raitt MH, et al.

Myocardial Infarction 52

Myocardial Infarction Pericarditis STEMI Angina 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. This was clearly severe subepicardial ischemia causing ST Elevation, but it was not of a long enough duration to result in measurable infarct.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

MIBHS

OCTOBER 15, 2024

Without oxygen, the cells would quickly die, leading to a heart attack (myocardial infarction). 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.

Circulation 52

Circulation Heart attacks Heart Attack Chest Pain 52

Dr. Smith's ECG Blog

APRIL 22, 2022

ST-elevation myocardial infarction after pharmacologic persantine stress test in a patient with Wellens’ syndrome. Single High-Sensitivity Cardiac Troponin I to Rule Out Acute Myocardial Infarction. Evaluating Rapid Rule-out of Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay at Presentation.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

DAIC

JANUARY 23, 2024

3 Patients with ASCVD are at a higher risk for major adverse cardiovascular events (MACE) including heart attack or myocardial infarction (MI), stroke, and cardiovascular (CV) death.4 The benefit was most significant in reducing the incidence of stroke and angina requiring revascularization.35 4 In the U.S. 12 Colchicine, 0.5

Cardiovascular Disease 111

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease 111

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.,

STEMI 52

STEMI Chest Pain Ischemia Myocardial Infarction 52

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. They can present with anterior wall infarction. In that case there was ST depression in I, aVL, II, aVF and V2-V6.

Stenosis 52

Stenosis Coronary Artery Bypass Graft Coronary Artery Disease Document 52

Dr. Smith's ECG Blog

JULY 31, 2018

This is diagnostic of myocardial infarction. 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.

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 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!

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart attacks 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Takotsubo is a sudden event, not one with crescendo angina. Such cases are classified as MINOCA (Myocardial Infarction with Non-Obstructed Coronary Arteries). I need to innoculate you against the subsequent opinions below. by making it clear to everyone that this is NOT an EKG that one sees with takotsubo cardiomyopathy.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

DECEMBER 19, 2018

This confirms that there were dynamic signs of ischemia on the initial ECG. ng/ml , a three-fold increase from troponin #2, also confirming acute myocardial infarction. This is particularly unusual, as T-wave normalization is usually unstable angina (negative troponin). The ST depression in aVL is also resolved.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

In the STEMI/NSTEMI dichotomy, NSTEMI is supposed to mean non-occlusive myocardial infarction, but this patient had transient Occlusion MI that was at risk for re-occlusion (like ‘transient STEMI’). Impact of total occluson of culprit artery in acute non-ST elevation myocardial infarction: a systemic review and meta-analysis.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Cardiology Update

APRIL 30, 2024

The highly impactful International Study of Comparative Health Effectiveness With Medical and Invasive Approaches ( ISCHEMIA ) trial investigated the effectiveness of invasive (INV) versus conservative (CON) strategies for managing stable coronary artery disease. EuroIntervention. 2024 Mar 5:EIJ-D-24-00011.

Coronary Artery Disease 119

Coronary Artery Disease Ischemia Outcomes Cardiac Arrest 119

Journal of the American Heart Association

FEBRUARY 27, 2024

We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. of invasive‐assigned women revascularized versus 81.2%

Ischemia 45

Ischemia Coronary Artery Disease Myocardial Infarction Outcomes 45

Cardiometabolic Health Congress

MAY 10, 2024

Major findings from the INTERHEART study reveal that stress is more common among cases of acute myocardial infarction (AMI) compared to controls. Results revealed that women are twice as likely to exhibit myocardial ischemia in response to mental stress compared to traditional stressors like exercise or pharmacologic stress.

Coronary Artery Disease 59

Coronary Artery Disease Obesity Chest Pain Ischemia 59

Dr. Smith's ECG Blog

JANUARY 28, 2012

The patient might be having cardiac ischemia, but if he is, it is unstable angina or non-STEMI, or perhaps he has not YET pseudonormalized, so serial ECGs may be important. Differential of peri-infarct pericardial fluid The differential includes 1) pericarditis with effusion or 2) hemopericardium.

Chest Pain 40

Chest Pain STEMI Pericarditis Ultrasound 40

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

It could also, given a different clinical context be compatible with a subacute myocardial infarction complicated by post infarct regional pericarditis. Due to the atypical and vague symptoms, the myocardial infarct was not initially diagnosed. At presentation he had a history of dyspnea for 6 days.

Chest Pain 89

Chest Pain Pericarditis Myocardial Infarction Dementia 89

Dr. Smith's ECG Blog

DECEMBER 6, 2024

Watch what happends as the heart recovers from its episode of ischemia. This is the c ulprit for the patient's non-ST elevation myocardial infarction AV groove circumflex, proximal LPDA, and mid LAD stenoses may also be hemodynamically significant Occlusion of the proximal nondominant RCA is not likely clinically relevant.

Coronary Artery Bypass Graft 107

Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis 107