Dr. S. Venkatesan MD

OCTOBER 29, 2024

One clue : We do prescribe this drug every day and it beats angioplasty. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. This conclusion is explicitly illustrated here, and the dramatically dissociated Kaplan and Myers would tell the whole story. Some of you may have got it right.

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Angioplasty Coronary Artery Disease Plaque Angina 52

Ken Grauer, MD

MAY 20, 2023

For example — We would not normally expect to see more ST elevation after PCI ( as we do in ECG #3 ) — unless reperfusion of the "culprit" artery with the procedure was not successful — or — unless additional ECGs done prior to PCI showed additional ST elevation occurred before angioplasty opened the occluded vessel.

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Blog Chest Pain Ischemia STEMI 145

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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Myocardial Infarction Chest Pain Ischemia Angina 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

Precordial ST depression may be subendocardial ischemia or posterior STEMI. I have warned in the past that one must think of other etiologies of ischemia when there is tachycardia. Whether it is subendocardial ischemia or posterior STEMI, if you cannot get it to resolve, you must activate the cath lab. There is no ST elevation.

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STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

APRIL 2, 2014

There is about 1 mm of STE in aVR I con sidered but rejected subendocardial ischemia. Is it subendocardial ischemia, or inferior MI? The RCA was opened with POBA ("plain old balloon angioplasty") and eptifibatide was started. The ST elevation vector is posterior, inferior, and right , to the right of lead III and also posterior.

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STEMI Ischemia Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

APRIL 18, 2024

5] Back to the case The patient had serial ECGs over the next hour with no significant change: The first troponin came back at 1,400 ng/L (normal <26 in males and <16 in females), confirming MI – and the patient’s refractory ischemia indicated this was an Occlusion MI.

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STEMI Chest Pain Myocardial Infarction Stents 124

Heart 2023 Conference

APRIL 20, 2022

Source: JAMA Cardiology) Patients with afib who survived an intracerebral haemorrhage had a very significant risk of cerebrovascular ischemia episodes and death in the following year, according to registry data. American College of Cardiology Journal) Are you thinking of stopping your antiplatelet medication too soon after angioplasty?

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Pulmonary Hypertension AFIB COVID-19 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. But the real question at hand is: Are these precordial ST-depressions a result of subendocardial ischemia?

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Chest Pain Myocardial Infarction STEMI Ischemia 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Rescue treatment with stenting, balloon angioplasty, and/or intraarterial thrombolysis or antiplatelets are often required to treat the underlying stenosis. IntroductionIntracranial atherosclerotic disease (ICAD) is associated with up to 32% of posterior circulation strokes.1

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Stents Stent Circulation Stroke 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.

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Myocardial Infarction Ischemia STEMI Cardiogenic Shock 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

Dr. Smith's ECG Blog

FEBRUARY 10, 2023

Inferior ST Depression does NOT mean there is inferior subendocardial ischemia; it is generally reciprocal to high lateral (aVL) subepicardial ischemia (OMI/STEMI) == MY Comment by K EN G RAUER, MD ( 2/10/2023 ): == There are certain patterns in ECG interpretation that experienced providers are able to immediately recognize.

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STEMI Ischemia Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

The patient continued to have ischemia after PCI, and in fact had an episode of polymorphic VT shortly after while in the ICU. Determinants and prognostic implications of persistent ST-segment elevation after primary angioplasty for acute myocardial infarction: importance of microvascular reperfusion injury on clinical outcome.

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STEMI Myocardial Infarction Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern). This is "shark fin" morphology. Code STEMI was activated.

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Cardiogenic Shock Chest Pain Tachycardia Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). The lesion was intervened on with balloon angioplasty and had subsequent TIMI 3 flow. In there ECG evidence of possible ongoing ischemia? (ie, There was initially TIMI 0 flow.

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Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Ken Grauer, MD

APRIL 9, 2023

As discussed in ECG Blog #108 — AIVR generally occurs in one of the following C linical S ettings : i ) As a rhythm during cardiac arrest; ii ) In the monitoring phase of acute MI ( especially with inferior MI ) ; or , iii ) As a reperfusion arrhythmia ( ie, following thrombolysis, acute angioplasty, or spontaneous reperfusion ).

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Blog Chest Pain Arrhythmia Cardiac Arrest 78

Dr. Smith's ECG Blog

OCTOBER 24, 2019

This strongly suggests reperfusing RCA ischemia. Troponins, echocardiogram An echocardiogram showed inferobasilar hypokinesis, further supporting a diagnosis of regional ischemia , likely of the area supplied by the RCA. There is also a Q-wave in III. There is also subtle STD in V3-V5. The initial troponin I was elevated at 0.75

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Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Anish Koka

MAY 16, 2023

The diagnosis typically requires classic clinical features, with no evidence of obstructive coronary disease, and typical findings of ischemia on functional studies. Women also had more cardiovascular risk factors, including hypertension (66.6% versus 63.2%; P <0.001), hyperlipidemia (68.9% versus 66.3%; P =0.004), older age (62.4±7.9

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia." Ongoing ischemia despite medical management has always been an indication for emergent cath, which is frequently ignored as it was in this case.

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Chest Pain STEMI Document Ischemia 52

Frontiers in Cardiovascular Medicine

NOVEMBER 21, 2024

BackgroundAnomalous aortic origin of a coronary artery (AAOCA) is associated with an increased risk of myocardial ischemia and sudden cardiac death. Patch angioplasty with a pulmonary artery patch and RCA reimplantation without cardiopulmonary bypass are viable and effective surgical options.

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Aortic Sudden Cardiac Death Outcomes Angioplasty 52