Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Cardiology was consulted and the patient underwent coronary angiogram which showed diffuse severe three-vessel disease. Coronary angiogram shows diffuse severe three-vessel disease. Episodes of angina over past couple of months had been progressive. High sensitivity troponin I rose to peak at 2900 ng/L.

Tachycardia 140

Tachycardia Cardiogenic Shock Angina Coronary Angiogram 140

BoardVitals - Cardiovascular

JUNE 14, 2017

The post 6 Cardiology Board Review Questions That Will Help You Pass the Boards appeared first on BoardVitals Blog. Question banks are a favorite exam preparation resource for Cardiologists that want to practice in the format of the exam. If you’d like more sample questions then follow this link to begin a free trial today.

Congenital Heart Disease 52

Congenital Heart Disease Coronary Angiogram Coronary Artery Disease Cardiovascular Disease 52

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.

Chest Pain 127

Chest Pain Blood Pressure Ischemia STEMI 127

Dr. Smith's ECG Blog

MAY 30, 2024

Will you accept this patient for emergent coronary angiogram based on the ECG changes? The patient is a 70 something female with chest discomfort and dyspnea. How would you interpret the ST changes seen in this ECG? Does the ECG represent STEMI-negative OMI findings? How would you mange this patient?

Ischemia 89

Ischemia Coronary Angiogram Pulmonary STEMI 89

Dr. Smith's ECG Blog

JUNE 19, 2024

The patient was taken emergently to the cath lab for a pericardiocentesis instead of a coronary angiogram. Regular readers of Dr. Smith's ECG Blog are well familiar with what is perhaps my favorite Stephen Smith Adage = "You diagnose acute pericarditis at your peril!"

Chest Pain 61

Chest Pain Pericarditis Pacemaker STEMI 61

Dr. Smith's ECG Blog

MAY 24, 2022

CT coronary angiogram is excellent , but is rarely available outside of business hours, and hardly ever at night. In the July 28, 2020 post in Dr. Smith’s ECG Blog — I cited my favorite on-line “Quick GO-TO” reference for the most common types of lead misplacement, which comes from LITFL ( = L ife- I n- T he- F ast- L ane ).

Chest Pain 52

Chest Pain Blog Coronary Angiogram Coronary Artery Disease 52

Dr. Smith's ECG Blog

JULY 2, 2023

Outcome The only followup we got was that the patient is undergoing Coronary Bypass (CABG) of LAD, 2nd Obtuse Marginal, and Left Posterolateral coronaries. We don't know if he had a stress test, a CT Coronary angiogram, or they just decided to do an angiogram. But thanks to you, I feel much more confident.

Chest Pain 52

Chest Pain Angina Coronary Angiogram Stents 52

CineECG

MAY 18, 2023

cineecg flow inferior wall infarct In this blog we will address a case of identifying a specific case of a heart infarct, in particular an infarct in the lower part of the heart (Inferior wall infarction ; RCA distal to the RV branch).

Blog 52

Blog Coronary Angiogram Heart Disease 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

A Coronary angiogram from 8 years prior revealed that he had had an inferior posterior STEMI at the time due to 100% occlusion of the proximal RCA. Regional wall motion abnormality- inferior and inferolateral.

Aneurysm 116

Aneurysm Chest Pain Echocardiogram STEMI 116

Dr. Smith's ECG Blog

MAY 19, 2022

Ct coronary angiogram showed normal coronary arteries. Smith note: I think CT coronary angiogram is reasonable with the elevated troponins and symptoms. He was given aspirin and heparin and transferred to the local cardiac center for further evaluation. He was diagnosed with mild AKI which resolved.

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

MARCH 17, 2023

She had a prior history of "NSTEMI" one month ago, during which she had a coronary angiogram reportedly showing no stenosis in any coronary artery. A very similar case to the one presented today appears in the January 17, 2023 post of Dr. Smith’s ECG Blog. Her vitals were within normal limits.

Chest Pain 52

Chest Pain Coronary Angiogram Circulation Electrocardiogram 52

EMS 12-Lead

APRIL 21, 2022

It’s judicious, then, to arrange for coronary angiogram. Coronary occlusion, however, might be present concurrently with subendocardial ischemia on the time-zero ECG, or evolve into such. elevated BP), but rather directly correlated with coronary obstruction and stymied TIMI flow. Does the ECG normalize? 2] Aslanger, E.,

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

A coronary angiogram was done that did not show significant coronary artery disease. I have periodically called attention to examples of the Ashman phenomenon as they occur in Dr. Smith's ECG Blog ( See My Comments in the January 5, 2020 post — the June 17, 2020 post — and the March 30, 2023 post , among others ).

Cardiac Arrest 69

Cardiac Arrest Cardiomyopathy Arrhythmia Atrial Fibrillation 69

BoardVitals - Cardiovascular

MAY 1, 2017

The post Hypertropic Cardiomyopathy: A Board Review Question Explained By Video appeared first on BoardVitals Blog. Start with a Free Trial.

Cardiomyopathy 52

Cardiomyopathy Sudden Cardiac Death Bicuspid/Mitral Electrocardiogram 52

Dr. Smith's ECG Blog

MAY 16, 2023

Like they would for any other acute arterial occlusion syndrome (such as suspicion of acute large vessel stroke), they take the patient across the hall and perform an immediate CT (coronary) angiogram, showing patent coronaries. An emergent echo also confirms no regional wall motion abnormality.

Chest Pain 52

Chest Pain Pericarditis Tachycardia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

We investigated the incidence of an acutely occluded coronary in patients presenting with STE-aVR with multi-lead ST depression. All electrocardiograms (ECGs) and coronary angiograms were blindly analyzed by experienced cardiologists. A normal PR interval.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

JUNE 19, 2023

NSTEMI paradigm doesn't care if you have imminently deadly acute coronary occlusion, unless you have STEMI criteria, ongoing ischemia after hours of delay, or until you start to have shock or arrest from it. Just another NSTEMI.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

JUNE 20, 2020

Discussion Thus, no further ECGs were recorded and there was no angiogram or stress test or CT coronary angiogram. Acute MI does not often present with syncope alone, without any other symptom, so the pretest probability of acute MI is low.

STEMI 52

STEMI Hospital Coronary Angiogram Dysrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Here is the coronary angiogram: A distal thrombotic right coronary artery (RCA) occlusion ! Cath lab was not activated because we diagnosed a "high risk" NSTEMI; rather, it was because we suspected, actively searched for, and could not refute an OMI that needs to be immediately reperfused.

STEMI 52

STEMI Chest Pain Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

Young people can suffer acute coronary occlusion, whether by typical atherosclerotic plaque rupture, or by coronary anomalies, coronary aneurysms, dissections, spasm, etc. The wall motion abnormalities of Takotsubo cardiomyopathy and LAD OMI can be similar.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

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. The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

MARCH 9, 2025

See this exemplified many times on this blog. Heitner et al found that in 14% of patients with NSTEMI, a blinded interventional cardiologist interpreting coronary angiograms identified a different culprit artery than CMR ( [link] ). Subendocardial ischemia does not localize. Anterior ST depression = posterior ST elevation.

Ischemia 89

Ischemia Blog STEMI Coronary Angiogram 89

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Angiogram Door to balloon time was 120 minutes (much too long) because of time taken for a CT. Coronary angiogram showed 100% mid LAD occlusion for which she received a DES with excellent angiographic result. It was not SCAD (coronary dissection) Highest troponin I was 37,000 ng/L, but it was not measured to peak.

Chest Pain 105

Chest Pain Aortic STEMI Ultrasound 105

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

The intricacies of the different classes of antiarrhythmics and their mechanism of action extend beyond the scope of this blog. CT coronary angiogram showed a hypoplastic RCA and dominant LCx. I list below links to other cases of idiopathic VT from Dr Smith's ECG blog. Try a different kind of antiarrhythmic.

Tachycardia 73

Tachycardia Arrhythmia Atrial Flutter Ablation 73

Dr. Smith's ECG Blog

MARCH 3, 2025

Case Continued The patient was discharged from the hospital with a plan for a scheduled coronary angiogram to assess the coronary arteries and the possibility of aortic valve replacement. The vast majority of ischemia from supply demand mismatch is diffuse ST depression, with ST Elevation in aVR.

Tachycardia 75

Tachycardia Pulmonary Chest Pain Stenosis 75