Dr. Smith's ECG Blog

JANUARY 5, 2024

So there is probability of myocardial injury here (and because it is in the correct clinical setting, then myocardial infarction.) Thus, the patient does not (yet) get a formal diagnosis of MI and must be called unstable angina unless further troponins return above the 99th percentile. Repeat ECG is shown below.

Angina 106

Angina Plaque Document Stent 106

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. 1] European guidelines add "regardless of biomarkers". But only 6.4% Clin Cardiol 2022 4. Herman, Meyers, Smith et al.

STEMI 117

STEMI Chest Pain Myocardial Infarction Stent 117

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. A New ST-segment elevation myocardial infarction equivalent pattern? An Impella was placed for cardiac output augmentation.

Chest Pain 82

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

Dr. Smith's ECG Blog

OCTOBER 24, 2018

It was stented. 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. Therefore this is " Transient ST Elevation Unstable Angina." As there was ruptured plaque, this is NOT Prinzmetal's angina.

STEMI 52

STEMI Angina Myocardial Infarction Plaque 52

Dr. Smith's ECG Blog

MARCH 9, 2013

A stent was placed. In my experience, all Wellens' with significant myocardial infarction have evolution from type A waves to type B waves over 6-24 hours' time , so that the presence of type A or type B waves, I believe, are simply a matter of the timing of recording and the rapidity of evolution. Lessons: 1. de Zwaan C.,

Myocardial Infarction 52

Myocardial Infarction Chest Pain Ischemia Angina 52

Dr. Smith's ECG Blog

MAY 20, 2024

The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia.

Chest Pain 122

Chest Pain Blood Pressure Ischemia STEMI 122

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. It was treated with and dual "kissing balloons" and drug eluting stents.

Myocardial Infarction 52

Myocardial Infarction Pericarditis Angina STEMI 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department Case 1. Widimsky P et al. This was a 100% acute LM occlusion.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 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.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 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’). Notice also that there is new T-wave inversion in III with upright T-wave in aVL, confirming inferior infarction.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

JUNE 28, 2018

Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J. Am Heart J.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Article 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

Dr. Smith's ECG Blog

MAY 10, 2023

ng/mL This single initial troponin at this level, in the context of chest pain, is high enough to be diagnostic of acute myocardial infarction. INTERVENTION * Successful angioplasty and stenting (drug eluting) of the mid LAD * Successful angioplasty of the ostial 1st diagonal Learning points: 1. Young women do get acute MI 2.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JULY 31, 2018

This is diagnostic of myocardial infarction. The lesion was stented. In middle age women, it accounts for 22-35% of all ACS presentations 1,3 , and the reported incidence of ST-elevation myocardial infarction in this subset of patients is variable, but estimated to be between 24-50% 4. Int J Cardiol. 2016.01.188.

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52