Dr. Smith's ECG Blog

APRIL 22, 2024

Patient is pain free and clearly has Wellens' syndrome: 1) pain free episode following an episode of angina, typical Pattern A (biphasic, terminal T-wave inversion with an initial upsloping ST Segment) findings, preserved R-waves. Angiography : --Culprit for the patient's unstable angina/Wellen syndrome is a ruptured plaque in the mid LAD. --As

Chest Pain 117

Chest Pain Myocardial Infarction Anatomy Angina 117

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. Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates. Severe Hypoxia b.

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Angina Ischemia Coronary Angiogram Stenosis 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 125

Chest Pain Blood Pressure Ischemia STEMI 125

Heart BMJ

JANUARY 29, 2024

There was no antecedent angina. The left system showed no disease in the left main stem, but mild plaque disease in the dominant left circumflex artery. Clinical introduction Vignette A man in his 40s presented to our emergency department with sudden onset of severe central chest pain radiating to his left arm.

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Chest Pain Angina Ultrasound Plaque 40

Heart BMJ

MARCH 22, 2024

Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials.

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Plaque Atherosclerosis Risk Factors Angina 40

Dr. S. Venkatesan MD

JANUARY 14, 2024

In addition, the criteria require the absence of precordial Q waves, the presence of history of angina, and normal or slightly elevated cardiac serum markers. It is generally believed it is more of a mechanical plaque lesion. Wellens is a glorified subset of ACS. It can be referred to as an ACS in a confused state of evolution.

Anatomy 52

Anatomy Angina STEMI Thrombosis 52

MIBHS

JULY 31, 2024

Sustained inflammation can damage your blood vessels, leading to atherosclerosis (plaque buildup) and increasing your risk of heart attack and stroke. This can lead to chest pain (angina) and increase your risk of heart attack or stroke, especially if you already have underlying heart disease.

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Blood Pressure Heart Attack Heart attacks Heart Rhythm 52

Dr. Smith's ECG Blog

DECEMBER 7, 2023

Learning Points: Type 1 MI is the type we are most familiar with: rupture of atherosclerotic plaque with production thrombus or platelet fibrin aggregates. Serial EKG is very high yield diagnostic test in patients with stuttering angina. But not all OMI is atherosclerotic in nature.

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SCAD Ischemia Coronary Artery Disease Cardiomyopathy 124

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Takotsubo is a sudden event, not one with crescendo angina. To prove there is no plaque rupture, you need to do intravascular ultrasound (IVUS). An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!! I need to innoculate you against the subsequent opinions below. It can only be seen by IVUS. MINOCA has many etiologies.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. S. Venkatesan MD

OCTOBER 29, 2024

This study tested PTCA vs with a single lipid lowering drug in terms of plaque regression. Bertram Pitt and his team scripted this from the Department of Medicine, University of Michigan School of Medicine, Ann Arbor, USA. One can’t expect even in your dreams a study like this would be be done in the future.

Angioplasty 52

Angioplasty Coronary Artery Disease Plaque Angina 52

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) A Selective Aldose Reductase Inhibitor (at-001) For the Treatment of Diabetic Cardiomyopathy: Primary Results of the Phase 3 Randomized Controlled ARISE-HF Study Efficacy and Safety of Ninerafaxstat, a Novel Cardiac Mitotrope, in Patients with Symptomatic Nonobstructive Hypertrophic Cardiomyopathy: Results of IMPROVE-HCM Topical (..)

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Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Sanjay Gupta

DECEMBER 19, 2022

She had some very minor plaque but certainly nothing that could explain the heart attack and therefore she was discharged with a diagnosis of MINOCA i.e MINOCA – When a heart attack is not a heart attack Keywords: MINOCA; MI with normal coronary arteries; Coronary vasospasm; Microvascular angina; Syndrome X; Prinzmetal angina.

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Heart Attack Heart attacks Blood Clot Chest Pain 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

Therefore it means acute type 1 ACS plaque rupture with impeded flow and impending full occlusion until proven otherwise. He presented with recent angina that evolved into a 3-hour episode of persistent CP unrelieved by rest. Then, the patients third ECG showed a very rare combination of de Winter T waves happening during LBBB.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

Dr. Smith's ECG Blog

MAY 10, 2023

LAD plaque with 0-25 percent stenosis. Now, with elevated troponins, Wellens' syndrome is likely. A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD CAD-RADS category 1. --No Given that the patient has had an abnormal elevated troponin, would suggest a Cardiology evaluation.

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Coronary Angiogram Chest Pain Stenosis STEMI 52

Frontiers in Cardiovascular Medicine

FEBRUARY 8, 2024

Objective Assessing the impact of lumbar disc herniation (LDH) on the plaque burden of coronary atherosclerosis is our objective. Methods In this study, a total of 212 patients (age 46–80 years) with unstable angina (UA) who underwent coronary angiography (CAG) in our hospital from January 2018 to July 2022 due to UA were included.

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Plaque Angina Myocardial Infarction Risk Factors 59

Dr. Smith's ECG Blog

JULY 31, 2018

Prog- nostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pecto- ris-Myocardial Infarction Multicenter Investigators in Japan. SCAD occurs in patients with few or non-traditional cardiovascular risk factors. Int J Cardiol. 2016;207:341–348. 2016.01.188.

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52

Circulation: Cardiovascular Imaging

MARCH 21, 2025

BACKGROUND:Recent studies have shown that vasospastic angina (VSA) is associated with myocardial bridge (MB) and pericoronary adipose tissue inflammation. Coronary plaques were qualitatively classified as noncalcified or calcified plaques in each vessel. Factors associated with VSA included male sex (74.5% versus 51.7%,P=0.01),

Angina 40

Angina Plaque Cardiovascular Imaging Circulation 40

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

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. Therefore this is " Transient ST Elevation Unstable Angina." As there was ruptured plaque, this is NOT Prinzmetal's angina. It is just as dangerous, as there is a ruptured plaque with thrombus (which lysed) in the proximal LAD.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

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. Any interruption in this process can result in serious consequences.

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Circulation Heart Attack Heart attacks Chest Pain 52

NOVARAD

APRIL 19, 2023

In a patient with CAD, atheromatous plaques build inside the coronary arteries, reducing the flow of oxygen-rich blood to the heart muscle by narrowing or blocking the arteries. The patient may then experience deadly angina, myocardial fraction, or heart attack.

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Coronary Artery Disease Heart Attack Heart attacks Angina 52

DAIC

JANUARY 23, 2024

Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 7 Research has shown inflammation plays a significant role in the development of atherosclerosis and ASCVD,8-10 and even the formation of plaque.11 4 In the U.S.

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Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Cardiology Update

APRIL 9, 2024

The primary endpoint consisted of a composite of all-cause mortality, MI, stroke, coronary revascularization, or hospitalization for unstable angina. These patients were identified to have non-flow-limiting vulnerable coronary plaques through intracoronary imaging. of patients in the PCI group compared to 3.4%

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Angina Myocardial Infarction Aortic valve Coronary Artery Disease 52

DAIC

MARCH 25, 2024

SHASTA-2—looks at a new medicine plozasiran on the treatment of hypertriglyceridemia SMART Trial—a head-to-head trial of the self-expanding vs. a balloon-expanding TAVR DanGer Shock—brings equipoise to how cardiogenic shock is treated in general, looking at the use of a transvalvular mico-axial flow pump in patients who have infarct or heart attack (..)

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Education Cardiogenic Shock Heart Failure Plaque 59

Dr. Smith's ECG Blog

MARCH 9, 2017

Here is another similar case: Dynamic T-wave inversion (apparent Wellens' waves), all troponins negative: Unstable Angina Sam's Learning Points : 1. For example, a coronary plaque ruptures: the vessel can undergo occlusion, spontaneous reperfusion, maybe reocclusion, again reperfusion, etc. Unstable Angina still exists.

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Chest Pain Angina Ischemia Plaque 52

Dr. Sanjay Gupta

DECEMBER 19, 2022

With time, fat and cholesterol can get trapped in the areas of wear and tear and cause plaque formation. The plaques can damage us in 2 ways. 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.

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Heart Rhythm Plaque Heart Attack Heart attacks 40

Heart BMJ

JANUARY 13, 2025

We investigated potential associations between cumulative atherosclerotic plaque burden quantified using the Gensini score, novel invasive indices of coronary microvascular function (microvascular resistance reserve (MRR); resistive reserve ratio (RRR)) and related INOCA endotypes. –11.0)), vasospastic angina (VSA) (4.5 (2.0–10.0)),

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Plaque Coronary Artery Disease Angina Physiology 52

Cardiometabolic Health Congress

NOVEMBER 22, 2024

Additionally, the ongoing ORBITA-2 trial examines the use of percutaneous coronary intervention (PCI) for stable angina, offering valuable insights into procedural benefits and outcomes​.

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Blood Pressure Obesity Preserved Ejection Fraction Coronary Artery Disease 59

Dr. Smith's ECG Blog

MARCH 25, 2025

I have said before, treating angina with morphine and continuing non-emergent management is like taking the batteries out of an actively alarming smoke detector during a house fire and going back to sleep. As per Dr. Frick use of intravascular imaging ( IVUS or OCT ) could have helped to find plaque rupture and identify the "true" culprit.

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Chest Pain Ischemia Plaque Stent 63

Dr. S. Venkatesan MD

JANUARY 22, 2025

One big chunk of ACS-UA is secondary UA where there is increased demand as in stable angina with tachycardia*. In these patients there is no plaque triggered ACS. For example, in a febrile patient who has associated HT, anemia, etc.,

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Coronary Angiogram Chest Pain Anatomy Angina 52

Dr. Smith's ECG Blog

MARCH 17, 2025

Nevertheless, the operator performed intravascular ultrasound and saw erupted calcium nodule consistent with plaque erosion. 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.

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STEMI Chest Pain Myocardial Infarction Document 80