Atherosclerosis and STEMI - Cardiovascular Update

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

There is an area of dense white in the middle of the circle consistent with atherosclerosis. They too have dense white masses consistent with coronary atherosclerosis. The cardiologist recognized that there were EKG changes, but did not take the patient for emergent catheterization because the EKG was “not meeting criteria for STEMI”.

Chest Pain

Chest Pain Blood Pressure Ischemia STEMI

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. Thus, angiography may be fairly accurate in determining lumen size, but it will not detect the “volume” of atherosclerosis present. He does have a recently diagnosed PE, and has not been taking his anticoagulation due to cost.

Ischemia

Ischemia Plaque Stenosis Myocardial Infarction

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

See "Mechanisms of acute coronary syndromes related to atherosclerosis".) STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. From Gue at al.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

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7 steps to missing posterior Occlusion MI, and how to avoid them

Dr. Smith's ECG Blog

JANUARY 3, 2022

Step 1 to missing posterior MI is relying on the STEMI criteria. A prospective validation of STEMI criteria based on the first ED ECG found it was only 21% sensitive for Occlusion MI, and disproportionately missed inferoposterior OMI.[1] But it is still STEMI negative. A 15 lead ECG was done (below). In a study last year, 14.4%

STEMI

STEMI Myocardial Infarction Chest Pain Ischemia

Hyperacute T-waves and Concordant ST Elevation seen in PVCs only

Dr. Smith's ECG Blog

OCTOBER 8, 2018

Steffen writes this case: "A few weeks ago I was able to recognize a STEMI because of what I had seen on your blog." "I He had no further risk factors for atherosclerosis besides hypertension. Steffen wrote: " I remembered the ECG from your blog titled: "STEMI Seen Best in PVC, Diagnosed by Medic, Ignored by Physician" from 2013.

STEMI

STEMI Chest Pain Blog Atherosclerosis

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

Considering their multidirectional effect on atherosclerosis, new inflammatory biomarkers integrating various leukocyte subgroups have been proposed to calculate the systemic inflammatory response index (SIRI) and systemic inflammatory index (SII).Aim:The The mean age of patients was 57.68 (SD= 11.19) years.

Angina

Angina Coronary Artery Disease Biomarkers Atherosclerosis

A coronary angiogram, that tends to cross the boundaries of your thoughts

Dr. S. Venkatesan MD

JUNE 26, 2024

Ostial Athero-sclerosis( Rare, but status of other areas of coronary artery will usually reveal evidence for atherosclerosis) True confirmation, is possible only during surgery , ie visulaing the absence of left coronary ostia. We know, how adverse is the outcome of Left main STEMI. Syphilis 2. Aorto arteritis 3.Ostial

Coronary Angiogram

Coronary Angiogram Cardiothoracic Anatomy Atherosclerosis

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

See "Mechanisms of acute coronary syndromes related to atherosclerosis".) STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. From Gue at al.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Chest Pain in a Male in his 20's; Inferior ST elevation: Inferior lead "early repol" diagnosed. Is it?

Dr. Smith's ECG Blog

JULY 31, 2013

We have found in our study comparing inferior STEMI (manuscript in preparation) to inferior early repol several distinguishing characteristics. Nevertheless, even young people have atherosclerosis and plaque rupture. And young women have worse outcomes than other groups with STEMI because of the tendency to say, "Nah, couldn't be!"

Chest Pain

Chest Pain Aneurysm STEMI Ischemia

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

This is a troponin I level that is almost exclusively seen in STEMI. So this is either a case of MINOCA, or a case of Type II STEMI. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. I believe the latter (type II STEMI) is most likely.

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Spontaneous coronary artery dissection Dissection of a coronary artery may occur in the context of atherosclerosis, or be iatrogennic during angiography or angioplasty. A recent study found that SCAD causes almost 20% of STEMI in young women. examined SCAD presenting as STEMI (unlike Hassan et al. A study by Hassan et al.

Chest Pain

Chest Pain SCAD STEMI Cardiogenic Shock

Anaphylaxis, chest pain, and ST elevation in aVR

Dr. Smith's ECG Blog

MARCH 1, 2023

A "STEMI alert" was called and soon cancelled. This pattern occurs regardless of whether the cause is ACS (decreased supply) or any other cause of decreased supply or increased demand. There is a tiny hint of STE in aVL, but overall I do not think this looks like high lateral OMI. Pain lasted for approximately 45 minutes.

Chest Pain

Chest Pain Ischemia Tachycardia Stenosis

The Bleeding Heart

EMS 12-Lead

APRIL 21, 2022

pre-existing, stable atherosclerosis) amidst any state of global duress – to include hypertension, hypoxia, tachycardia, hypotension, sepsis, and GI bleed, for example. STEMI was activated and the patient went to Cath on arrival. There may even be significant overlap between these factors.

Ischemia

Ischemia Myocardial Infarction Blog Coronary Angiogram

An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Webinars

7 steps to missing posterior Occlusion MI, and how to avoid them

Hyperacute T-waves and Concordant ST Elevation seen in PVCs only

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

A coronary angiogram, that tends to cross the boundaries of your thoughts

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Chest Pain in a Male in his 20's; Inferior ST elevation: Inferior lead "early repol" diagnosed. Is it?

1 hour of CPR, then ECMO circulation, then successful defibrillation.

A young peripartum woman with Chest Pain

Anaphylaxis, chest pain, and ST elevation in aVR

The Bleeding Heart

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