Dr. Smith's ECG Blog

AUGUST 4, 2024

Two weeks ago he had a significant MVC with many severe injuries, including aortic injury s/p endovascular repair. The clinical reality is that the overwhelming majority of cases in Dr. Smith's ECG Blog, in which acute pericarditis is strongly considered as the diagnosis based on ECG findings — turn out not to be the result of pericarditis.

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Pericarditis Chest Pain Blog Aortic 116

AMS Cardiology

APRIL 16, 2024

If you’ve been diagnosed with aortic stenosis, you might have come across the term TAVR. our blog aims to clearly outline this procedure and how it can significantly improve your quality of life. Understanding Aortic Stenosis The aortic valve regulates blood flow from your heart’s main pumping chamber to the rest of your body.

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Aortic valve TAVR Aortic Open-Heart Surgery 40

Dr. Smith's ECG Blog

JUNE 27, 2024

Smith comment: Go here for a comprehensive blog post on syncope and link to the most detailed version of the Canadian Syncope Rule: Emergency Department Syncope Workup. See these blog posts. EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport.

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Blog Pacemaker Bradycardia Tachycardia 120

Dr. Smith's ECG Blog

DECEMBER 24, 2023

Written by Pendell Meyers A woman in her 20s with connective tissue disorder and history of aortic root and valve repair presented with palpitations. Further history revealed she had new onset atrial flutter soon after her aortic surgery, and was put on flecainide approximately 1 month ago. Here is her triage ECG: What do you think?

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Atrial Flutter Blog Aortic Aortic valve 126

Dr. Smith's ECG Blog

MAY 20, 2024

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. Edited by Smith He also sent me this great case.

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Chest Pain Blood Pressure Ischemia STEMI 125

Penn Heart and Vascular Blog

MAY 18, 2022

The aortic valve is the largest of the heart's 4 valves and controls how blood is pumped from the left ventricle into the aorta. Learn how to keep it healthy.

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Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Another possible cause of pseudonormalization of T waves mentioned many times on this blog is the pseudonormalization caused by re-occlusion of an infarct related reperfused coronary artery. Since serial ECGs are not available so either of the two patterns described above could be present (only serial ECG could differentiate).

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Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Post PCI an intra-aortic balloon pump (IABP) was placed and a combination of norepinephrine and dobutamine was needed to maintain perfusion pressures. The image quality is not the best, but you can see the subtotal occlusion of the left main artery. Below is a still image with the red arrow indicating the subtotal LMCA stenosis.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

FEBRUARY 12, 2024

Angiogram: Severe 95% hazy distal LM Severe 80% ostial LAD, 100% occluded distal LAD thought to be due to distal embolization from the lesion in the proximal LAD.

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Pericarditis Chest Pain Bradycardia Aortic 104

ECG Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

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Chest Pain STEMI Blog Embolism 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

The next morning the patient went for his routine echocardiogram, where the operator noticed a dilated aortic root at 5.47 cm with severe aortic insufficiency. The team was notified and they ordered a stat aortagram which showed type A aortic dissection from the aortic valve to the iliacs.

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Pericarditis Chest Pain Aortic Blog 52

ECG Cases

JANUARY 1, 2018

Many huge thanks to the entire EM Cases team, Advisory Board, SREMI, the amazing guest experts and you, the listeners of the podcasts, readers of the blogs, viewers of the videos and participants in the course, for making 2017 another successful year for EM Cases! And here they are.

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Cassling

MAY 25, 2023

The Midwest company will begin offering EchoSolv, an artificial intelligence clinical decision support platform designed to help detect severe aortic stenosis, to providers throughout the country. Omaha, Neb. –

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Stenosis Aortic Innovation Blog 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

I've copied KEY points from My Comment in the August 6, 2022 post in Dr. Smith's ECG Blog — regarding the answer to this question. Figure-1: The initial ECG in today's case. What are the ECG Findings of Cardiac Contusion? The ECG is less than optimally sensitive for detecting cardiac injury following blunt trauma.

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Look at the aortic outflow tract. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Aortic angiogram did not reveal aortic dissection. In fact, bedside ultrasound might even find severe aortic stenosis. What do you see?

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Ischemia Cardiogenic Shock Aortic Stenosis 40

MIBHS

JANUARY 4, 2023

If you don’t know the answers to these questions, then this is blog is going to answer all of your questions about the heart’s structure. The aortic semilunar valve is between the left ventricle and the aorta. However, not everyone knows much about the actual the heart’s structure. What are the major arteries and veins?

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Bicuspid/Mitral Heart Valves Pulmonary Blog 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

A dissection flap is noted in the intrabdominal aorta, and the aortic outflow tract is also noted to appear wider than normal. The CT angio showed a type A aortic dissection extending from the aortic root proximally to the carotid and left subclavian artery and distally to the common femoral arteries.

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Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

OCTOBER 11, 2020

Like other cases on this blog who died before cath was done, I cannot prove that this patient had OMI. We have countless cases of missed posterior MI on this blog, including these: Interventionalist at the Receiving Hospital: "No STEMI, no cath. He was admitted to the cardiology floor and diagnosed with an NSTEMI. Were they right?

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Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

OCTOBER 4, 2010

An echocardiogram confirmed aortic stenosis with a large pressure gradient. Now there is much less ST segment deviation, less elevation and less depression. The troponin returned positive, and the maximum troponin was 3.8 The next day, and angiogram showed normal coronary arteries. He awoke and did well.

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Cardiac Arrest Ischemia STEMI Stenosis 52

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

The first troponin returned at 0.099 ng/mL (elevated, consistent with Non-Occlusion MI) Providers were concerned with aortic dissection, so they order a chest aorta CT. Here is here initial ECG: There is only a nonspecific flat T-wave in aVL. It is essentially normal.

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Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

SEPTEMBER 14, 2014

At that previous visit, he had had some mildly elevated troponins, but mostly had severe heart failure from very poor systolic function and aortic stenosis. He has had previous angiograms showing "large vessels" and "no significant coronary disease." LV Ejection Fraction at the time of this hospitalization was 10%.

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Chest Pain Pacemaker Cardiomyopathy STEMI 52

BoardVitals - Cardiovascular

MAY 1, 2017

While the first one may radiate to the axilla and base, but usually not into the neck, it does reflect both aortic outflow obstruction and mitral regurgitation in patients with a large gradient. On the other hand, the murmur in valvular aortic stenosis does not change substantially or decreases slightly following the Valsalva maneuver.

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Cardiomyopathy Sudden Cardiac Death Bicuspid/Mitral Electrocardiogram 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. We’ve presented many variations on this theme on Dr. Smith’s Blog — with today’s case being distinguished by its discovery on abdominal exam ! Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g.,

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Ischemia STEMI Stenosis Chest Pain 52

Global Cardiac Surgery

SEPTEMBER 9, 2018

Today, for the third blog of this series, Global Cardiac Surgery is featuring Vietnam, a lower-middle-income country in Southeast Asia with a long standing experience and leading example for cardiac surgery in the Region. In addition, several centers are now performing minimally invasive aortic and mitral valve procedures with good results.

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Open-Heart Surgery Bicuspid/Mitral Congenital Congenital Heart Disease 52

Dr. Smith's ECG Blog

MARCH 6, 2023

Due to the severity of the pain and the high BP, they obtained an aortic dissection CT. For more on the Mirror Test for recognizing posterior OMI — See My Comment in the September 21, 2022 post in Dr. Smith's ECG Blog ). especially since this Chest CT was done to rule out aortic dissection ).

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Chest Pain STEMI Stenosis Blog 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

Cardiology noted there was no STEMI criteria and the first troponin was in the normal range (25ng/L, with normal <26), so alternate diagnoses were considered and the patient was sent for CT to rule out aortic dissection. Selected LINKS on this Topic: ECG Blog #246 — Reviews the concept of the "Mirror Test" with a clinical example.

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STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. On arrival his BP was 70s/40s, so an intra-aortic ballon pump was placed.

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Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

MARCH 13, 2024

Given radiation of pain into the patient's back, he underwent CTA which showed no evidence of aortic dissection or any other acute pathology. By definition , this is acute myocardial infarction, the only question now is the etiology.

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Chest Pain Angina Echocardiogram Myocardial Infarction 108

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

They also wanted an aortic CT which was negative. The chart says that "Cardiology agrees that the first ECG is early repolarization and similar to previous," but recommended giving aspirin and starting heparin and to wait for the first troponin to discuss. This is a "Transient OMI".

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Chest Pain Myocardial Infarction STEMI Pericarditis 115

Dr. Smith's ECG Blog

APRIL 24, 2015

The estimated left ventricular ejection fraction is 58 % Aortic stenosis, mild, 9.0 The patient thus did not need immediate angiography. An echocardiogram showed: Left ventricular hypertrophy concentric. mmHg mean gradient. cm^2 valve area.

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Cardiac Arrest Defibrillator Atrial Fibrillation Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The patient had no hypertension, no tachycardia, a normal hemoglobin, no drug use, no hypotension/shock, no murmur of aortic stenosis. We also looked at his aortic root by both parasternal and suprasternal views, and the aorta was normal.]

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Chest Pain STEMI Aortic Pulmonary 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

As we've discussed on numerous other posts in Dr. Smith's ECG Blog ( See My Comment at the bottom of the page in the May 5, 2022 post) — a growing number of conditions other than Brugada Syndrome have been found to temporarily produce a Brugada-1 ECG pattern. What are the ECG Findings of Cardiac Contusion?

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Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

MAY 10, 2023

No signs for aortic dissection or pulmonary embolus. --"Results were discussed with the ordering physician. A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD LAD plaque with 0-25 percent stenosis. CAD-RADS category 1. --No

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Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JUNE 4, 2019

The patient arrived looking like an aortic dissection patient, so CTA was done and negative." ST elevation at 60 ms after the J-point in lead V3 = 1.5 mm Value using 400 ms QTc = 18.83 (significantly higher than 18.2 and thus indicating LAD occlusion). This all suggests a wraparound type III LAD to the inferior wall.

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Chest Pain STEMI Ischemia Aortic 52

Dr. Smith's ECG Blog

APRIL 9, 2023

CT Aortogram revealed: No pulmonary embolism, No aortic dissection. Therefore, a patient with persistent pain and a troponin at this level has Acute MI with ongoing ischemia and should go to the cath lab regardless of the ECG (this is by American and European guidelines).

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Chest Pain Ischemia Stenosis Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. That said — acute MI does occur in younger patients ( witness the case referred to above by Dr. Smith — as well as the links from Dr. Meyers at the end of his discussion that refer to multiple cases published on Dr. Smith’s ECG Blog of young adults with acute MI ).

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Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JULY 22, 2012

Blunt cardiac injury my result in : 1) Acute myocardial rupture with tamponade 2) Valve rupture (tricuspid, aortic, mitral) 3) Coronary thrombosis or dissection (and thus Acute MI) from direct coronary blunt injury 4) Dysrhythmias of all kinds.

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