Post-stent chest pain, revisited
Heart Sisters
JULY 28, 2024
Heart patients with persistent or recurrent post-stent chest pain present “an unmet clinical need”, according to the European Journal of Cardiology.
H/o MI and stents with brief angina has this ED ECG. And what is Fractional Flow Reserve?
Dr. Smith's ECG Blog
JANUARY 31, 2020
A middle-aged man complained of 15 minutes of classic angina that resolved upon arrival to the ED. Angiogram: Widely patent RCA and LAD stents. Therefore, no stent was placed. (No It is proven better than angiography alone in stable angina , and also has been shown to improve decisions on stenting non-culprit lesions in ACS.
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Diabetic patient who had 12 stents in his heart underwent a successful Beating Heart Surgery.
Dr. Prateek Bhatnagar
MAY 11, 2022
A 55 years old diabetic male patient who had 12 stents in his heart underwent a successful beating heart bypass surgery under Dr. Prateek Bhatnagar, Director Cardiac Surgery. The patient was suffering with angina (chest pain) since 2002. He received these 12 stents on 5 different occasions at 5 different hospitals of the twin cities.
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Successful Bypass Surgery In Hyderabad After Stents Blocked in Delhi.
Dr. Prateek Bhatnagar
SEPTEMBER 6, 2023
Prateek Bhatnagar Director Cardiac Surgery, on a 50 years man after stents placed in his left main coronary artery at Delhi just 3 months back, had blocked. Mr. Hemant, a resident of Delhi NCR, had developed chest pain (angina). He subsequently underwent stenting procedure in left main coronary artery.
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Three normal high sensitivity troponins over 4 hours with a "normal ECG"
Dr. Smith's ECG Blog
JANUARY 5, 2024
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. On the basis of unresolved angina, cardiology decided to perform rescue PCI. RCA and PDA before and after, arrows indicating stented regions. Repeat ECG is shown below.
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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.
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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.
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
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TMVR after TA-TAVR: a re-redo surgery—case report
Frontiers in Cardiovascular Medicine
MAY 19, 2024
In this case report, the authors describe the successful TMVR as a tertiary cardiac surgery and transapical redo procedure.Case SummaryAn 83-year-old male patient, suffering from dyspnoea and angina, was diagnosed with severe mitral valve regurgitation (MR).
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Asia’s first “Live” liver donor gets successful high risk beating heart bypass surgery
Dr. Prateek Bhatnagar
OCTOBER 27, 2020
He next underwent stenting in his coronary arteries in 2000, 2010 and 2012 at Pune. A total of 6 stents were placed. He recently developed unstable angina. Coronary angiography showed multiple blocks in the stents, needing an urgent bypass surgery. He himself developed heart disease a couple of years later.
63 year old with "good story for ACS" but negative troponins.
Dr. Smith's ECG Blog
JULY 2, 2023
This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." I said that this is unstable angina until proven otherwise. Thus, Unstable Angina. Troponins negative."
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Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution
The British Journal of Cardiology
APRIL 16, 2024
We present the cumulative percutaneous coronary intervention (PCI) data of all comers (stable angina and acute coronary syndromes [ACS]) who presented to Hadi Clinic between January 2018 and December 2020. and the average number of stents 2.6. The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,
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Abstract 4125093: Association of Systemic Inflammatory Index and Systemic Inflammatory Response Index with Major Adverse Cardiovascular Events in Patients with Acute Coronary Syndrome Who Had Primary Percutaneous Coronary Intervention
Circulation
NOVEMBER 11, 2024
Types of ACS include stable angina 5.3% (n=8), unstable angina 24% (n=36), NSTEMI 28.7% (n=43), and STEMI 24% (n=36). All patients had interventional PCI with balloon and stent insertion. The mean age of patients was 57.68 (SD= 11.19) years. The mean of SIRI was 24.45 (SD=25.49) and the mean of SII was 663.30 (SD= 403.75).
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Optimal Predilatation Treatment Before Implantation of a Magmaris Bioresorbable Scaffold in Coronary Artery Stenosis: The OPTIMIS Trial
Circulation: Cardiovascular Interventions
JANUARY 20, 2025
BACKGROUND:Bioresorbable scaffolds (BRS) were developed to overcome limitations related to late stent failures of drug-eluting stents, but lumen reductions over time after implantation of BRS have been reported. Circulation: Cardiovascular Interventions, Volume 18, Issue 1 , Page e014665, January 1, 2025. versus 6.31.5 versus 7.51.7
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Abstract 4139995: Scoring System-Based Approach for Identifying Patients With Positive Intracoronary Acetylcholine Provocation Tests: The Original and Modified ABCD Score
Circulation
NOVEMBER 11, 2024
Background:Although intracoronary acetylcholine (ACh) provocation testing is a guideline-recommended invasive standard for the diagnosis of vasospastic angina (VSA), ACh tests are largely underused in clinical practice globally. Circulation, Volume 150, Issue Suppl_1 , Page A4139995-A4139995, November 12, 2024. Recently, Rinaldi et al.
A device?related fistula between coronary artery and left atrial appendage following left atrial appendage closure: Case presentation
Journal of Cardiovascular Electrophysiology
MARCH 11, 2024
Methods and Results A 67-year-old male with a history of LAAC was referred to our emergency room with recurrent chest pain and palpitations and was diagnosed with ischemic angina pectoris.
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?
Dr. Smith's ECG Blog
MAY 20, 2024
If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. This was a presumed culprit and a stent was placed. The angiogram showed scattered mild luminal irregularities of the LAD, the LCx, and the RCA and a 95% distal RCA occlusion in a right dominant system.
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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
A stent was placed. When there is extremely brief ischemia, as in this case , or this case , it may entirely reverse, especially in unstable angina (negative troponins). Angiographic and clinical characteristics of patients with unstable angina showing an ECG pattern indicating critical narrowing of the proximal LAD coronary artery.
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Is OMI an ECG Diagnosis?
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%
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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.
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). It was stented.
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See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens
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. The reappearance of de Winter's pattern caused by acute stent thrombosis: A case report. Am J Emerg Med. 2014;32:e5–e8. As per Drs.
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Watch what happens when "pericarditis" and morphine cloud your judgment
Dr. Smith's ECG Blog
JULY 3, 2018
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. The patient underwent successful placement of one drug eluting stent with restoration of TIMI 3 flow.
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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.
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If you had recorded an ECG during chest pain, what would it have shown?
Dr. Smith's ECG Blog
JUNE 28, 2018
Angiographic and clinical characteristics of patients with unstable angina showing and ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Am Heart J. 1982 Apr;103(4 Pt 2):730-6. de Zwaan C et al. Am Ht J 117(3): 657-665; March 1989. Here is the first post-cath ECG (ECG #4).
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New ORBITA Findings May Offer Modest Symptomatic Pain Relief To Interventional Cardiologists
CardioBrief
MAY 22, 2018
New data presented at EuroPCR from the much debated ORBITA trial may provide some modest temporary lessening of the pain felt by interventional cardiologists in response to the initial negative ORBITA findings. But the pain relief is likely to be only temporary, and might even be fairly compared to a placebo effect, since the major.
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A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day
Dr. Smith's ECG Blog
MAY 10, 2023
INTERVENTION * Successful angioplasty and stenting (drug eluting) of the mid LAD * Successful angioplasty of the ostial 1st diagonal Learning points: 1. The RCA was normal in appearance and free of obstructive disease. Young women do get acute MI 2.
Occlusion/reperfusion through 6 ‘normal’ ECGs
Dr. Smith's ECG Blog
FEBRUARY 10, 2022
Delayed angiogram found a 95% mid RCA occlusion that was stented. Notice also that there is new T-wave inversion in III with upright T-wave in aVL, confirming inferior infarction. And notice that the T-waves in V4-V6 are now back down to normal size and "bulk."
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Do Stents Make You Feel Better?
Dr. Paddy Barrett
DECEMBER 5, 2023
The logic of stenting obstructed coronary arteries is simple. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. But coronary stenting is not the only way to reduce symptoms of angina.
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An athletic 30-something woman with acute substernal chest pressure
Dr. Smith's ECG Blog
JULY 31, 2018
The lesion was stented. 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. It seems that there was some uncertainly about this. Int J Cardiol. 2016;207:341–348.
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GE HealthCare and Medis Medical Imaging Announce Collaboration Focused on Non-Invasive Coronary Assessments to Help Advance Precision Care in Treatment of Coronary Artery Disease
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.
Percutaneous Coronary Interventions Using a Ridaforolimus?Eluting Stent in Patients at High Bleeding Risk
Journal of the American Heart Association
JANUARY 12, 2024
Drug‐eluting stents have been shown to be superior to bare‐metal stents in patients with HBR, even when patients were given abbreviated periods of dual antiplatelet therapy (DAPT). Short DAPT has not been evaluated with the EluNIR ridaforolimus‐eluting stent.
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A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?
Dr. Smith's ECG Blog
SEPTEMBER 19, 2023
Past medical history includes coronary stenting 17 years prior. If you take old people with a history of MI (he had a stent), that percentage goes far higher since there is scar tissue that acts as a nidus for the PVCs that initiate VT. Episodes of angina over past couple of months had been progressive.
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Management and outcomes of spontaneous coronary artery dissection: a systematic review of the literature
Frontiers in Cardiovascular Medicine
JANUARY 15, 2024
with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. SCAD-PCI revascularization frequently required three or more stents and had residual areas of dissection. Approximately 48.5% and 1.3%, respectively.
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Johnson and Johnson to Acquire Shockwave Medical
DAIC
APRIL 5, 2024
IVL helps restore blood flow by cracking calcium lesions using sonic pressure waves and is used in both CAD and PAD, often in combination with stenting. a company that has developed the Reducer System, a novel product focused on symptom relief of refractory angina. The Reducer System has a growing commercial presence.
Is this a STEMI? No, not by definition! Why not? Why is this Important?
Dr. Smith's ECG Blog
OCTOBER 24, 2018
It was stented. Therefore this is " Transient ST Elevation Unstable Angina." As there was ruptured plaque, this is NOT Prinzmetal's angina. Here are many other cases of Unstable Angina , in spite of Eugene Braunwald's Requiem for Unstable Angina. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, There was good flow.
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Subtle Dynamic T-waves, Followed by LAD Occlusion and Arrest
Dr. Smith's ECG Blog
MARCH 9, 2017
She was found to have a 100% occlusion of her Mid LAD just after the takeoff of D1 - which was reperfused and stented. Here is another similar case: Dynamic T-wave inversion (apparent Wellens' waves), all troponins negative: Unstable Angina Sam's Learning Points : 1. Unstable Angina still exists. This is very dangerous thinking.
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Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?
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 It was treated with and dual "kissing balloons" and drug eluting stents. hours when she called 911. TIMI flow is 0. Door to balloon time was 51 minutes.
Highlights of ACC 2024
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. The primary non-inferiority endpoint was MACCE (a composite of cardiac death, MI, ischaemic stroke, stent thrombosis, or target vessel revascularisation). in the medical therapy group.
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Rise of the Lysenkoist Cardiologists
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.
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How does Acute Total Left Main Coronary occlusion present on the ECG?
Dr. Smith's ECG Blog
AUGUST 9, 2019
Beware crescendo angina in patient with known CAD ST Elevation in aVR Case 7. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. And thus it is a hybrid of de Winter's T-waves and Diffuse subendocardial ischemia. Another left main occlusion, but this one shows subendocardial ischemia.
Case Report: Dual-lumen microcatheter-facilitated wiring technique to correctly access a protruded aorto-ostial stent: a case series
Frontiers in Cardiovascular Medicine
MARCH 5, 2025
BackgroundPercutaneous coronary intervention (PCI) through the aorto-ostial coronary stent that is protruding into the aorta remains a technical challenge because of the poor coaxial alignment of the guiding catheter and the inability to advance the guidewire into the distal vessel through the stent's central lumen.
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Dizziness in a 40-something with recent stent for inferior OMI
Dr. Smith's ECG Blog
DECEMBER 29, 2024
Was it unstable angina? Well, really, in this case, there was no angina, only "dizziness") I don't think so. The patient ruled out for MI by serial troponins < 3 ng/L. Why did they get smaller? I think that T-waves can have some evolution even without infarction.
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Look what happens when you advocate for your patient with a skeptical cardiologist.
Dr. Smith's ECG Blog
APRIL 11, 2025
He then provided some history: " Classic story for angina, few hours of crushing chest pain." Here is the cath report (TIMI-2 flow in the circumflex -- stented): Learning Point: Just because the cardiologist says it is "not a STEMI" and "wants to teach you about the ECG", it does not mean you should back down.
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Successful pharmaco-mechanical treatment of a subtotally occluded venous bypass graft in a patient presenting with acute coronary syndrome: a case report and review of the current literature on the role of local thrombolysis
Frontiers in Cardiovascular Medicine
MARCH 17, 2025
This case report discusses a 75-year-old male patient who presented with angina and shortness of breath due to thrombus formation in a venous graft 20 years after CABG. Coronary artery bypass grafting (CABG) is a common and effective treatment for patients with complex coronary artery disease.
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