Angioplasty, Myocardial Infarction and Stenosis

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

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J. 2000;139:430–436. Am J Cardiol.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m.

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

Association of coronary angiographic lesions and mortality in patients over 80 years with NSTEMI

Open Heart

JANUARY 31, 2022

Objective Coronary angiography (CA) and percutaneous coronary intervention (PCI) is of great importance during non-ST-segment elevation myocardial infarction (NSTEMI) management. Conclusion Coronary lesions (>50% stenosis) are strong predictors of mortality in elderly patients with NSTEMI. –7.6) and HR 4.5 (1.6–12.5).

Myocardial Infarction

Myocardial Infarction Stenosis Angioplasty Heart Disease

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An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Timing of revascularization in patients with transient ST segment elevation myocardial infarction: a randomized clinical trial. A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Lemkes et al. Am Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Pericarditis

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

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. Am Heart J (1989) 117 : pp 657-665. de Zwaan C.,

Chest Pain

Chest Pain Myocardial Infarction Ischemia Angina

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

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. LAD plaque with 0-25 percent stenosis. If trops are negative and there is <50% stenosis, then the patient is safe for discharge, even if the HEART score or EDACS score are elevated.

Coronary Angiogram

Coronary Angiogram Chest Pain Stenosis STEMI

If you had recorded an ECG during chest pain, what would it have shown?

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.

Chest Pain

Chest Pain Myocardial Infarction STEMI Article

A man in his 50s with chest pain

Dr. Smith's ECG Blog

MARCH 9, 2023

Read our recent editorial: Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined. Note that this obvious STEMI does not have 100% stenosis at the time of cath. It showed a mid LAD culprit with 95% with no pre intervention timi flow listed. Pol Arch Intern Med. 2017;127:401–411.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients. In the setting of evolving infarction — development of AIVR often heralds the onset of reperfusion ( following thrombolysis, acute angioplasty, or spontaneous reperfusion ).

Chest Pain

Chest Pain SCAD STEMI Blog

Compare these two ECGs. Do either, neither, or both show anything important?

Dr. Smith's ECG Blog

APRIL 17, 2023

Cath around 1730: Left main: normal LAD: prox LAD 30% stenosis immediately followed by a "99-100% thrombus filled occlusion" involving the proximal and mid LAD, as well as a large diagonal branch, with TIMI 1 flow pre-procedure. Next trop 85,528 ng/L (consistent with a massive myocardial infarction), none further measured.

Chest Pain

Chest Pain STEMI Document Ischemia

Impact of Diabetes on Outcomes in Left Main Coronary Revascularization: PCI vs. CABG

Cardiology Update

MARCH 25, 2024

Among the patients included, those with diabetes exhibited higher rates of adverse events, including death, spontaneous myocardial infarction (MI), and repeat revascularization. Patients were stratified based on diabetes status, and various outcome measures were assessed using Kaplan-Meier event rates and Cox model hazard ratios.

Diabetes

Diabetes Coronary Artery Bypass Graft Outcomes Coronary Artery Disease

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With or Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials

Circulation

MARCH 11, 2024

Patients with diabetes experienced higher rates of 5-year death (158/1104 [Kaplan-Meier rate, 14.7%] versus 297/3289 [9.3%];P<0.001), spontaneous myocardial infarction (MI; 67/1104 [6.7%] versus 114/3289 [3.7%];P<0.001), and repeat revascularization (189/1104 [18.5%] versus 410/3289 [13.2%];P<0.001).

Coronary Artery Bypass Graft

Coronary Artery Bypass Graft Diabetes Coronary Artery Disease Stents

How does Acute Total Left Main Coronary occlusion present on the ECG?

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. TIMI 0/1 flow).(61,62) Knotts et al.

Myocardial Infarction

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

Rise of the Lysenkoist Cardiologists

Dr. Anish Koka

MAY 16, 2023

Marked differences can be seen in the prevalence of coronary artery stenosis at autopsy by age and gender. In 30-39 year old women the rate of coronary stenosis at autopsy was 5/1,545 (0.3%) while 60-69 year old men had a prevalence of 12%, almost 40 times higher. The results of this dataset by age and gender follow.

Chest Pain

Chest Pain Coronary Artery Disease Cancer Heart Attack

Cardiovascular Update

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

Association of coronary angiographic lesions and mortality in patients over 80 years with NSTEMI

Webinars

An elderly male with shortness of breath

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

If you had recorded an ECG during chest pain, what would it have shown?

A man in his 50s with chest pain

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Compare these two ECGs. Do either, neither, or both show anything important?

Impact of Diabetes on Outcomes in Left Main Coronary Revascularization: PCI vs. CABG

Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Left Main Disease With or Without Diabetes: Findings From a Pooled Analysis of 4 Randomized Clinical Trials

How does Acute Total Left Main Coronary occlusion present on the ECG?

Rise of the Lysenkoist Cardiologists

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