All About Cardiovascular System and Disorders

MAY 19, 2024

Transcatheter aortic valve replacement (TAVR) is increasing in popularity for symptomatic severe aortic stenosis. Transfemoral arterial route is the most commonly used approach for TAVR, also known as TAVI or transcatheter aortic valve implantation. No calcifications in the artery causing vascular stenosis. JACC: Asia.

Aortic valve 40

Aortic valve Aortic TAVR Open-Heart Surgery 40

Journal of Cardiothoracic Surgery

APRIL 11, 2024

The second case is a 76-year old male brought to the emergency room after sudden syncope, clinical sings of pericardial tamponade and suspicion of a type A acute aortic dissection. Immediate sternotomy under mechanical resuscitation enabled removal of the massive intrapericardial clot and revealed LVFWR.

Ischemia 52

Ischemia Myocardial Infarction ICU Aortic 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionAcute spinal cord ischemia syndrome (ASCIS) is a rare disease that is thought to comprise roughly only 1.2% A diagnostic spinal angiogram was completed with no evidence of arteriovenous fistula or aortic dissection. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023. of all strokes [1, 2].

Ischemia 40

Ischemia Myocardial Infarction Thrombosis Stroke 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). What do you think?

Cardiogenic Shock 128

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 128

Dr. Smith's ECG Blog

MAY 5, 2024

He interprets here: "This EKG is diagnostic of right bundle branch block and transmural ischemia of the anterior wall, most likely from an occlusion of the proximal LAD. The provider had sent the patient for an aortic dissection scan which had shown extremely heavy calcification of the LAD. It was recorded at 0530: What do you think?

EKG Technician 124

EKG Technician Chest Pain Blog STEMI 124

Dr. Smith's ECG Blog

OCTOBER 4, 2010

There is profound LVH with anterolateral ST elevation and reciprocal ST depression in II, III, aVF, and ST depression in V5 and V6 that could all be secondary to LVH or could represent ischemia superimposed on the repolarization abnormalities of LVH: note that wherever there is ST depression, it is associated with a very high voltage R-wave.

Cardiac Arrest 52

Cardiac Arrest Ischemia Stenosis STEMI 52

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. 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.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Frontiers in Cardiovascular Medicine

JANUARY 3, 2024

The degree of ischemia-reperfusion injury (IRI), which occurs during the harvest and implantation of the grafts, is an important determinant of graft patency. There was also a non-ischemia-reperfusion control group ( n  = 8). Introduction Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure.

Coronary Artery Bypass Graft 64

Coronary Artery Bypass Graft Transplant Ischemia Aortic 64

Dr. Smith's ECG Blog

DECEMBER 18, 2022

The differential is: Posterolateral OMI or subendocardial ischemia The distinction between posterior OMI and subendocardial ischemia can be important and sometimes difficult. A dissection flap is noted in the intrabdominal aorta, and the aortic outflow tract is also noted to appear wider than normal.

Chest Pain 40

Chest Pain Ischemia Aortic Aortic valve 40

Dr. Smith's ECG Blog

APRIL 24, 2015

Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. and repeat the ECG, to see if the apparent ischemia persists. A third ECG was done about 25 minutes after the first: This shows resolution of all apparent ischemia.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Atrial Fibrillation Ischemia 52

EMS 12-Lead

JULY 24, 2023

It should be known that each category can easily manifest the generic subendocardial ischemia pattern. In general, subendocardial ischemia is a consequence of global supply-demand mismatch that usually ameliorates upon addressing, and mitigating, the underlying cause. What’s interesting is that the ECG can only detect ischemia.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

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. That said — I did not interpret these differences as the result of acute ischemia. Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain.

Pericarditis 116

Pericarditis Chest Pain Blog Aortic 116

Ken Grauer, MD

JUNE 6, 2023

Part of the ST depression with deep T wave inversion in the lateral chest leads clearly reflects LV "strain" from the marked LVH — but despite the very large QRS amplitudes, this ST-T wave appearance looks disproportionate, suggesting at least a component of ischemia. The plan was to proceed as soon as possible with aortic valve replacement.

Blog 78

Blog Pulmonary Hypertension Aortic 78

All About Cardiovascular System and Disorders

APRIL 21, 2024

FFR is obtained by dividing the pressure distal to the stenosis by the central aortic pressure, which is usually equal to the pressure proximal to the stenosis if there is no additional stenosis in between. indicates inducible ischemia while an FFR above 0.80 excludes ischemia in 90% of cases. Normal FFR is 1.0 An FFR below 0.75

Myocardial Infarction 52

Myocardial Infarction Stents Stent Coronary Artery Disease 52

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?

Atrial Flutter 126

Atrial Flutter Blog Aortic Aortic valve 126

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

Left ventricular afterload reduction is essential to decrease the trans-se ptal pressure gradient and thus decrease shunt volume, making a larger proportion of the blood flow from the left ventricle through the aortic valve. Surgical repair of the VSR was eventually done.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Stroke Journal

JANUARY 30, 2025

The two groups exhibited similar patient characteristics, anatomical factors including aortic arch, and clinical outcomes. Left TRA may offer a safer and more reliable approach for various aortic arch configurations and for both right- and left-sided carotid lesions. years, 83.7%, and 53.5% in the right TRA group, and 74.8

Stents 40

Stents Stent Aortic Interventional Cardiology 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.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 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. and morphine 4 mg IV ( Smith : this is even more worthless, and just hides the fact that the patient is having ongoing ischemia and infarction) , and repeat ECG was obtained.

Chest Pain 108

Chest Pain Angina Echocardiogram Myocardial Infarction 108

Dr. Smith's ECG Blog

APRIL 9, 2023

remain hypo- or akinetic for some time even if not infarcted, just due to the profound ischemia incurred during the occlusive phase. Thus, an acute wall motion abnormality is not a sign of active or persistent ischemia, and thus is not necessarily an indication for emergent cath. Even many NOMI have wall motion abnormalities.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

All About Cardiovascular System and Disorders

MARCH 26, 2024

Then, in PDA Eisenmenger, you can have aortic enlargement because the shunt is received in the aortopulmonary region, aorta can be enlarged in PDA Eisenmenger. In VSD Eisenmenger, there is no aortic enlargement, there is no cardiomegaly. And it was described from the very first report of Eisenmenger syndrome.

VSD 52

VSD Pulmonary Hemorrhage Hypertension 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

2] Here there is no posterior ST elevation, but the anterior ST depression is also less—so it is dynamic, confirming acute ischemia. The absence of STE in V7-V9 is often due to resolution of ischemia, as seen by resolution of ST depression in V7-V9. But it is still STEMI negative.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think?

Tachycardia 115

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

EMS 12-Lead

MAY 20, 2022

There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. There is LBBB-like morphology with persistent patterns of subendocardial ischemia.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

JUNE 4, 2019

The patient arrived looking like an aortic dissection patient, so CTA was done and negative." Resolution of pain, by itself, is not reliable enough to be certain of resolution of ischemia. the ischemia has truly resolved. ST elevation at 60 ms after the J-point in lead V3 = 1.5 and thus indicating LAD occlusion).

Chest Pain 52

Chest Pain STEMI Ischemia Aortic 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. This transmural ischemia, but not necessarily completed infarction (yet).

Chest Pain 52

Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was What do you think? Does he need a stress test? --Is

STEMI 40

STEMI Chest Pain Cardiac Arrest Stents 40

Dr. Smith's ECG Blog

OCTOBER 3, 2017

On arrival his BP was 70s/40s, so an intra-aortic ballon pump was placed. This means that they occur shortly after onset of occlusion, but also may be the last remaining sign of ischemia after ST elevation resolves (after reperfusion). A repeat ECG was done: Obvious anterolateral wall STEMI.

Chest Pain 52

Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

JUNE 28, 2019

There was concern for aortic dissection, so a CT was done and was negative. For coronary anatomy, see here: [link] This is the post intervention ECG: All ST Elevation is gone (more proof that it was all a result of ischemia) Formal Echo: Normal estimated left ventricular ejection fraction - 55%. It was stented. Learning Points: 1.

Chest Pain 52

Chest Pain Pericarditis Stents Stent 52

DAIC

JANUARY 23, 2024

1,2 ASCVD causes or contributes to conditions that include coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease (inclusive of aortic aneurysm).3 mg reduced the risk of cardiovascular death, MI or heart attack, ischemic stroke, or ischemia-driven coronary revascularization by 31% compared with placebo.34

Cardiovascular Disease 111

Cardiovascular Disease Heart attacks Heart Attack Coronary Artery Disease 111

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiac arrest — and especially Hyperkalemia. Patients with such conditions that may transiently mimic the ECG findings of a Brugada-1 pattern are said to have Brugada Phenocopy.

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. He spent several days in the PICU, undergoing workup including: Serial troponins: rising from 5,700 ng/L (unknown if I or T) to greater than 25,000 ng/L (greater than the lab's upper limit of reporting). No further troponins were measured.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Evidence of acute ischemia (may be subtle) vii. heart auscultation (aortic stenosis); c. 2nd or 3rd degree AV blocks or sinus pause of at least 2 seconds iv. Right bundle branch block (BBB) with hemiblock (bifascicular block) v. Left BBB vi. LVH or RV d.

Arrhythmia 52

Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

But it also shows a massive area of total ischemia in the LAD territory: CT shows the infarct The CT is with contrast, which increases density (which looks more white). Important: It is exceedingly rare for an anterior STEMI to be due to Aortic Dissection. Here it is: Type A Aortic Dissection Why was the troponin so elevated?

Chest Pain 105

Chest Pain STEMI Aortic Ultrasound 105

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. ResultsThe median age at surgery was 26 years (range, 13–57 years).

Aortic 52

Aortic Sudden Cardiac Death Angioplasty Outcomes 52

Dr. Smith's ECG Blog

MARCH 3, 2025

The patient was started on heparin for possible NSTEMI vs demand ischemia. Smith : "decompensation" of aortic stenosis might have initiated this entire cascade. Smith : "decompensation" of aortic stenosis might have initiated this entire cascade. What "initiates" the aortic stenosis cascade?

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73