The roles of neutrophils in cardiovascular diseases
Frontiers in Cardiovascular Medicine
MARCH 18, 2025
Finally, we also emphasize the preclinical/clinical translational significance of neutrophil-targeted strategies.
ECG Cases 45 ECG in Weakness and Neurological Symptoms
ECG Cases
SEPTEMBER 12, 2023
Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing (..)
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PO-06-191 TRANSCATHETER EXTRACTION OF A FOSSA OVALIS FLAP PRESENTING AS ACUTE STROKE POST ATRIAL FIBRILLATION ABLATION
HeartRhythm
APRIL 30, 2024
Strokes and silent ischemia remain a serious complication of atrial fibrillation catheter ablation (AFCA). This is mainly due to extensive ablation lesions in the left atrium that create large areas of endothelial injury that produces prothrombotic states during and after AFCA.
Syncope and Atrial fibrillation in a Healthy 70-something Male
Dr. Smith's ECG Blog
JULY 5, 2018
PMH: Known paroxysmal Atrial fib. He is usually is in sinus rhythm as far as he knows, but he cannot subjectively feel atrial fibrillation, so he is never completely certain when he is in sinus or atrial fib. Here is his ECG: Atrial Fib with a Ventricular Response of about 66. He immediately completely recovered.
Abstract DP39: Short-term Outcomes of Atrial Fibrillation Patients Undergoing Carotid Stent Placement or Carotid Endarterectomy in the United States
Stroke Journal
JANUARY 30, 2025
Background:Patients with atrial fibrillation were excluded from clinical trials evaluating carotid artery stent(CAS) or carotid endarterectomy (CEA).We We used the ICD-10 to identify patients hospitalized with diagnosis of stroke, TIA, or retinal ischemia with stenosis of carotid artery who underwent CAS or CEA. versus 18.8%
Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.
Dr. Smith's ECG Blog
NOVEMBER 26, 2018
Chart review confirmed that he had been started on flecainide for atrial fibrillation. This new information makes the diagnosis of atrial flutter far more likely: first, atrial fibrillation and flutter are closely associated and, second, this makes a flutter rate of 200 bpm (with 1:1 conduction) quite likely.
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What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?
Dr. Smith's ECG Blog
MARCH 15, 2023
Her Apple Watch suddenly told her that she is in atrial fibrillation. Patients with healthy AV nodes who are not on AV nodal blockers and who are not hyperkalemic should have a rapid ventricular response if they have paroxysmal Atrial fibrillation. Exam was completely normal except for an irregular heart rate.
What is this ECG finding? Do you understand it before you hear the clinical context?
Dr. Smith's ECG Blog
FEBRUARY 2, 2024
Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. There is also large T wave inversion and long QT.
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Abstract WP11: The Safety of Emergent Anticoagulation in Acute Ischemic Stroke in Non-Atrial Fibrillation Indications: A Retrospective Analysis
Stroke Journal
FEBRUARY 1, 2024
Introduction:Patients with acute ischemic stroke (AIS) often present with conditions that require emergent anticoagulation (AC) other than atrial fibrillation (AF). intraluminal floating thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, DVT and PE) within 3 days of symptom onset.
Abstract 4143007: Pericoronary fat attenuation index as a Novel Tool to predict the morbidity of new-onset atrial fibrillation in patients with myocardial infarction with nonobstructive coronary artery disease
Circulation
NOVEMBER 11, 2024
Background:Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardial ischemia, but no clear stenosis of coronary artery imaging sign. The pericoronary fat attenuation index (FAI) could reflect the local coronary inflammation as a novel imaging marker.
Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.
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Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?
Dr. Smith's ECG Blog
APRIL 24, 2015
Here was his initial ED ECG: There is atrial fibrillation with a rapid ventricular response. ST depression is common BOTH after resuscitation from cardiac arrest and during atrial fib with RVR. and repeat the ECG, to see if the apparent ischemia persists. A middle-aged male had a V Fib arrest. This was done.
See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.
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?
This ECG is pathognomonic and you must recognize it.
Dr. Smith's ECG Blog
OCTOBER 26, 2015
Due to bradycardia, a 12-lead ECG was obtained: There is atrial fibrillation at a rate of 54. Slow atrial fibrillation implies an sick AV node, or one affected by electrolytes, ischemia, or medications/drugs. This patient was found with a bottle of alcohol and altered mental status. His breath alcohol was 0.259.
Does this ST Depression Maximal in V3 Represent Posterior OMI?
Dr. Smith's ECG Blog
AUGUST 17, 2022
Atrial fib may cause Occlusion mimic." ACUTE MI (I allowed Acute MI to be in the report because I knew there would be an elevated troponin from ischemia, which is the definition of acute MI -- but in this case it would most likely be a Type 2 MI from tachycardia) There is also LA-RA lead reversal.
Should we activate the cath lab? A Quiz on 5 Cases.
Dr. Smith's ECG Blog
OCTOBER 8, 2023
Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. The ECG does not show any signs of ischemia. True Positive ECG#2 : Also sinus rhythm. There is ST depression in V1.
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Approval, Evidence, and “Off-Label” Device Utilization: The Patent Foramen Ovale Closure Story
Circulation: Cardiovascular Quality & Outcomes
JANUARY 8, 2024
We quantified PFO closure among individuals with ≥2 years of preprocedure coverage to establish indications, classified hierarchically as stroke/systemic embolism, migraine, transient ischemia attack, or other.Results:We identified 5315 patients undergoing PFO closure (51.8% for transient ischemia attack, 8.8% female, 29.2%≥60
A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?
Dr. Smith's ECG Blog
JANUARY 9, 2024
She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. Are you confident there is no ischemia? The heart rate could be compatible with that of a 2:1 conducted atrial flutter. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)?
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Changing or Retaining Direct Oral Anticoagulant After Ischemic Stroke Despite Direct Oral Anticoagulant Treatment
Journal of the American Heart Association
JANUARY 31, 2024
BackgroundThe optimal antithrombotic strategies for patients with atrial fibrillation who experience ischemic stroke (IS) despite direct oral anticoagulant (DOAC) therapy remain inconclusive. Journal of the American Heart Association, Ahead of Print.
Pediatric Exercise Testing
All About Cardiovascular System and Disorders
MARCH 25, 2024
Pediatric exercise testing may be used for evaluation of various disorders of cardiac rhythm rather than for inducible ischemia as in adults. This measurement has been correlated with those made at electrophysiology study and may predict the potential risk of rapid anterograde conduction if the person develops atrial fibrillation.
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Cardiac arrest: even after the angiogram, the diagnosis is not always clear
Dr. Smith's ECG Blog
OCTOBER 28, 2013
The rhythm is nearly regular, but there are no P-waves (it is too regular to be atrial fibrillation). So, in this patient with incessant ventricular fibrillation that has been converted, there is now a supraventricular rhythm with RBBB. Was this: 1) ACS with ischemia and spontaneous reperfusion? at the time of the ECG.
Does this T wave pattern mean anything?
Dr. Smith's ECG Blog
OCTOBER 23, 2023
Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction.
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Abstract 4145884: Left ventricular 3D-sphericity is associated with 92 genetic loci
Circulation
NOVEMBER 11, 2024
Analyses of cardiovascular magnetic resonance imaging (MRI) in the MESA cohort have shown that LV sphericity is an important mode of variation in cardiac structure that is associated with ischemia, heart failure, and atrial fibrillation. Ldsc heritability was 29.7% for sphericity in diastole and 26.0% for sphericity in systole.
A teenager involved in a motor vehicle collision with abnormal ECG
Dr. Smith's ECG Blog
FEBRUARY 6, 2024
The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think?
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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?
Dr. Smith's ECG Blog
NOVEMBER 4, 2022
Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. Anything more on history?
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American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary
DAIC
FEBRUARY 29, 2024
24 will focus on the following three current guideline updates: American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines 2023 Atrial Fibrillation Guideline - Pharmacology II: Strokes vs. Bleeds, What Do the Guidelines Tell Us About Practical Management in A-fib? The Guidelines Sessions at ACC.24
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This middle-aged patient presented with SOB, weakness, and mild pulmonary edema.
Dr. Smith's ECG Blog
JANUARY 22, 2020
She previously had Atrial fibrillation with LBBB. This shows atrial fibrillation. The fact that the response is regular proves that the atrial fibrillation is NOT conducting. When atrial fib conducts, the ventricular rate must always be irregular. There was no evidence of ischemia.
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Morphine + OMI is a bad combination
Dr. Smith's ECG Blog
SEPTEMBER 24, 2023
The medical care providers ascribed the patient's chest pain to new onset atrial fibrillation with rapid ventricular response after having viewed the ECG. The presentation ECG does show atrial fibrillation. No further episodes of atrial fibrillation occurred during monitoring. The first ECG is shown below.
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Young Man with Very Fast Regular Wide Complex Tachycardia
Dr. Smith's ECG Blog
JUNE 28, 2023
It is dangerous in WPW with atrial fibrillation. In Atrial Fibrillation, the tachycardia will always be irregularly irregular. In Atrial fib with WPW, there will be polymorphic QRS complexes (in this case, all QRS complexes are identical). VT is not harmed by adenosine, When is adenosine dangerous?
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Avocados for the Heart; Cardiology's Sad State; CBD for Pulmonary Hypertension?
Heart 2023 Conference
APRIL 20, 2022
Harvard University Heart Letter) A clinical polygenic risk score test for diseases ranging from atrial fibrillation (AFib) to breast cancer was piloted by scientists. Avocado consumption of at least two servings per week is linked to a lower risk of cardiovascular disease.
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Brugada Syndrome: Diagnosis and Risk Stratification
All About Cardiovascular System and Disorders
OCTOBER 26, 2023
They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. Atrial fibrillation and Brugada syndrome. mV or R/q ≥ 0.75. Heart Rhythm. 2016 Oct;13(10):e295-324.
Why is ECG machine use? What diseases can EKG monitor detect?
Wellnest
DECEMBER 21, 2022
Atrial Fibrillation Atrial fibrillation causes irregular heartbeat, and the heart's normal blood supply is affected. Since atrial fibrillation can also be intermittent, such patients should continuously monitor their heart activity while performing daily activities with a portable ECG device.
Abstract TP252: Forward Head Posturing as a Significant Risk Factor for Posterior Circulation Infarcts
Stroke Journal
FEBRUARY 1, 2024
Objective:Forward head posturing (FHP) has been associated with chronic anatomic vertebral artery disturbances possibly leading to posterior circulation ischemia. Stroke, Volume 55, Issue Suppl_1 , Page ATP252-ATP252, February 1, 2024. The data supporting FHP as a true risk factor of posterior circulation stroke has not been well established.
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Abstract TP195: Impact of Intracranial Atherosclerotic Disease on Thrombectomy Outcomes in Acute Cerebral Infarction With Large Vessel Occlusion
Stroke Journal
FEBRUARY 1, 2024
Successful recanalization was defined as Thrombolysis in Cerebral Ischemia score ≥2b. ICAD group had lower atrial fibrillation frequency, lower BNP levels, more M1 occlusions, and fewer M2 occlusions compared to the Embolic group.
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Abstract TP188: Diving MCA and First-Pass Reperfusion: A Subgroup Analysis of the Arise II Study
Stroke Journal
FEBRUARY 1, 2024
The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b on first pass. Group C patient were more likely to have renal disease and atrial fibrillation (P<0.05). The total cohort was trichotomized into 3 groups (A, B, C) based on M1 tortuosity tertiles.
A man in his 30s with cardiac arrest and STE on the post-ROSC ECG
Dr. Smith's ECG Blog
OCTOBER 10, 2022
The rhythm is atrial fibrillation. In terms of ischemia, there is both a signal of subendocardial ischemia (STD max in V5-V6 with reciprocal STE in aVR) AND a signal of transmural infarction of the inferior wall with Q wave and STE in lead III with reciprocal STD in I and aVL. The QRS complex is within normal limits.
Abstract 262: National Trends of 90?day Readmission Rates and Etiologies among Diabetics following Transient Ischemic Attack
Stroke: Vascular and Interventional Neurology
NOVEMBER 9, 2023
IntroductionTransient Ischemic Attack (TIA) is a common neurologic condition characterized by temporary, focal cerebral ischemia that results in reversible neurological deficits without tissue infarction. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023.
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7-day ECG monitoring provides major benefits and is low on resource use
Cardiomatics
JULY 14, 2022
A recent study published in Nature / Scientific Reports aimed to detect the rate of atrial fibrillation (AF) and further cardiac arrhythmias after acute ischemic stroke. The authors of the study stated that rhythm disturbances may also lead to brain ischemia. “AF
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A woman in her 60s with large T-waves. Are they hyperacute, hyperkalemic, or something else?
Dr. Smith's ECG Blog
MAY 1, 2023
edits by Meyers A woman in her 60s with a history of chronic atrial fibrillation on Eliquis, ESRD on hemodialysis, type-II diabetes mellitus, prior CVA, hypertension, and hyperlipidemia presented to the emergency department with multiple complaints after missing dialysis. Case written by Brandon Friedman M.D., She was discharged home.
2023 STS Coronary Conference Agenda
Society of Thoracic Surgeons - Allied Health
FEBRUARY 14, 2023
CABG and Concomitant Ablation for Atrial Fibrillation, Left Atrial Appendage Management – How I Do It Niv Ad, MD (Silver Spring, MD, USA) 7:57 a.m. Posterior Pericardiotomy to Prevent Postoperative Atrial Fibrillation and How I Do It Mario Gaudino, MD, PhD, MSCE (New York, NY, USA) 8:05 a.m.
Hypothermia at 18 Celsius in V Fib arrest: CPR, then ECMO rewarming, for 3 hours, then Defib with ROSC. Interpret the ECG.
Dr. Smith's ECG Blog
FEBRUARY 8, 2022
Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.
Anterior MI in paced rhythm, dismissed by cardiologist, patient died.
Dr. Smith's ECG Blog
OCTOBER 3, 2018
underlying atrial fibrillation or atrial inactivity). There is no way the ST-T wave should change from lead V4-to-V5 as we see here given the similar all negative QRS appearance in these 2 leads, unless there is acute ischemia. Answer: There is a regular wide complex that looks like LBBB but there are no P-waves (i.e.,
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A woman in her 60s with palpitations
Dr. Smith's ECG Blog
APRIL 24, 2022
Here is her post-cardioversion ECG: ECG#2 - Immediately post cardioversion: Appropriate ST depression maximal in V5-6 and lead II, secondary to subendocardial ischemia, likely residual from the preceding tachycardia. This allows greater specificity for determining the extent of high lateral and inferior lead ischemia or infarction.
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3 days of shoulder and chest pain, and now cardiogenic shock
Dr. Smith's ECG Blog
AUGUST 28, 2020
This is ischemia until proven otherwise. ECG from 2 days later: Atrial Fibrillation now. A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock. This explains the long QT.
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