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. The echocardiogram showed a normal EF without any abnormalities. Although it is somewhat of a misnomer, it portends high grade AV block.

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Blog Pacemaker Bradycardia Tachycardia 120

Dr. Smith's ECG Blog

APRIL 12, 2023

A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think?

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Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

It is a known OMI mimic that we have shown on the blog many times. The emergent echocardiogram showed normal EF, no WMA, and normal valve function. This situation has been named "Emery phenomenon." In other words, the inferior "ST elevation" is due to the abnormal rhythm, and does not signify OMI or STEMI in any way.

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Chest Pain Tachycardia STEMI Blog 131

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

See this post: What do you think the echocardiogram shows in this case? Previously placed stents in the LAD (multiple) and mid circumflex and patent Formal echocardiogram: Normal left ventricular size and wall thickness. Shortly thereafter , the troponin came back at 3,129 ng/L (very high).

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

Dr. Smith's ECG Blog

JUNE 23, 2024

Echocardiogram showed LVEF 66% with normal wall motion and normal diastolic function. The electrophysiologist is a reader of Dr. Smith's ECG Blog. The above said — it may prove insightful to take another look at the Wellens' Syndrome case instantly recognized by Dr. Smith in the August 12, 2022 post in Dr. Smith’s ECG Blog.

Chest Pain 119

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 119

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

EKG initially negative but repeat shows a few T wave abnormalities… There is a chance this could be non-cardiac pain” At 1518, an echocardiogram showed normal LV size and systolic function with hypokinesis of the mid and distal anterior wall and the mid and distal septum.

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Chest Pain Blog Hospital Tachycardia 121

Dr. Smith's ECG Blog

MARCH 9, 2024

This would have been fairly easy and much more expedient to diagnose with bedside echocardiogram. The constellation of dyspnea, tachycardia, and (relatively) low voltage on ECG should prompt immediate evaluation for pericardial effusion and tamponade.

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Chest Pain Pericarditis Aortic Echocardiogram 118

Dr. Smith's ECG Blog

JUNE 11, 2024

Formal echocardiogram: Systolic function is at the lower limits of normal. We have shown many examples of this on this blog. To add to this complexity ( as per My Comment in the August 22, 2020 post in Dr. Smith's ECG Blog ) — the ST-T wave appearance in repolarization variants may be dynamic ! No further follow up is available.

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Chest Pain STEMI Blog Exercise 114

Dr. Smith's ECG Blog

JULY 11, 2024

Because: 1) He has been reading this blog for a long time. An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. An echocardiogram showed an EF of 20-25%. This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech.

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Outcomes Stenosis Outpatient Echocardiogram 113

Dr. Smith's ECG Blog

DECEMBER 9, 2023

And then a slightly more remote past ECG Old inferior MI The patient's previous echocardiogram report was viewed: Decreased LV systolic performance, estimated left ventricular ejection fraction is 35%. Case continued The patient underwent an emergency formal echocardiogram and it was unchanged. Cath Lab activation was cancelled.

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Aneurysm Chest Pain Echocardiogram STEMI 116

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

She underwent exercise echocardiogram in mid October where she exercised for nearly 7 minutes on the standard Bruce protocol and had typical anginal pain and shortness of breath. Baseline echocardiogram showed moderate LV systolic dysfunction with no wall motion abnormalities. There is inferoseptal hypokinesis.

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Chest Pain Echocardiogram Blog Ischemia 78

Dr. Smith's ECG Blog

OCTOBER 30, 2023

So the artery had completely spontaneously reperfused prior to intervention; the duration of occlusion was perhaps 2 hours The troponin peaked at 60,000 ng/L (a very large infarction) Formal bubble contrast echocardiogram --The estimated left ventricular ejection fraction is 46%. Regional wall motion abnormality-inferior.

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STEMI Heart Failure Stents Stent 124

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.

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Congenital Heart Disease Coronary Angiogram Coronary Artery Disease Cardiovascular Disease 52

Dr. Smith's ECG Blog

OCTOBER 15, 2024

Additionally, a bedside echocardiogram showed no wall motion abnormality and normal LV function. A formal echocardiogram for patient 2 showed normal LV size, wall thickness, and global systolic function. The two cases were considered: Patient 1 was recognized by the ED provider and the cardiologist as having resolved “STEMI”.

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Chest Pain STEMI Echocardiogram Stents 117

Dr. Smith's ECG Blog

JANUARY 1, 2024

A rapid echocardiogram was performed, revealing an ejection fraction of 20% with thinning of the anterior-apical walls. See My Comment at the bottom of the page in the May 19, 2020 post in Dr. Smith's Blog ). The initial troponin T level was measured at 30 ng/L.

Tachycardia 113

Tachycardia Blog Ischemia Heart Failure 113

Dr. Smith's ECG Blog

JULY 14, 2023

Formal Echocardiogram: Normal left ventricular size and wall thickness. As I emphasized in My Comment at the bottom of the page in the October 10, 2022 post in Dr. Smith's ECG Blog — Interpretation of a post-resuscitation ECG can be extremely challenging. First — Some thoughts on the post -resuscitation ECG.

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Echocardiogram was obtained and showed mild LVH without regional wall motion abnormality. For a list of lead reversal cases we've discussed in Dr. Smith's ECG Blog — GO TO the bottom of the page in My Comment from the January 6, 2024 post). Following PCI, the patient ruled out by troponins : troponin increased to 0.08 ng/mL and 0.10

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STEMI Document Blog Ischemia 116

Dr. Smith's ECG Blog

DECEMBER 19, 2023

His echocardiogram showed normal wall motion. From My Comment in the November 14, 2019 post in Dr. Smith's ECG Blog: A subject well worth periodic review — is the concept of Terminal QRS Distortion ( T-QRS-D ). The patient did well afterward without any recurrence of symptoms. There are no further EKGs or troponin measurements.

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Plaque Angina Blog Stents 127

Cassling

JUNE 20, 2024

This is the world’s only AI platform built on the world’s largest database of echocardiograms linked to mortality. One of our partners, Echo IQ, recently sought FDA approval for their AI-based cardiology workflow, EchoSolv.

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Ultrasound Echocardiogram Outcomes Blog 52

Dr. Smith's ECG Blog

AUGUST 26, 2024

The area of insult was indeed large, but whether that area is all irreversibly infarcted or not would require MRI or a 6 week followup ("convalescent") echocardiogram, to see how much myocardium recovers (was only "stunned", not infarcted) Post PCI EKG: There is loss of anterior forces (Q-waves) which was not there before.

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Myocardial Infarction Critical Care Echocardiogram Ischemia 122

Dr. Smith's ECG Blog

MARCH 13, 2024

Nossen also pointed out that with voltage this high in the limb leads, you would typically expect some degree of inferior/inferolateral ST depression (the so-called "LVH strain" pattern), and in fact this patient did have severe LVH on subsequent echocardiogram (which Dr. Nossen did not know at the time). The troponin peaked at 25749 ng/L.

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Chest Pain Angina Echocardiogram Myocardial Infarction 108

Dr. Smith's ECG Blog

JUNE 17, 2024

Echocardiogram showed severe RV dilation with McConnell’s sign and an elevated RVSP. Nicholson and Meyers provide numerous links at the end of their discussion to insightful related cases of acute PE that we've presented in Dr. Smith's ECG Blog. The patient was upgraded to the ICU for closer monitoring.

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Chest Pain Embolism Pulmonary Tachycardia 139

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Hopefully a repeat echocardiogram will be performed outpatient. 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. Systolic function normal by visual assessment only, unable to visualize well for further characterization. 2300: QRS now within normal limits.

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 116

Dr. Smith's ECG Blog

DECEMBER 11, 2023

We have shown that morphine is associated with worse outcomes (see learning points below) and have published many blog posts about it , such as this one: Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief). The case continues. The patient suffered a large infarct.

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Myocardial Infarction Chest Pain STEMI Blood Pressure 123

Dr. Smith's ECG Blog

JANUARY 15, 2024

ECG 2 Especially in the context of the first ECG, readers of this blog will readily appreciate the ST elevations and hyperacute T waves in II, III, aVF, V6, and to a lesser extent V5. As discussed on this blog many times before, proportionality is key to the diagnosis of OMI by ECG. [link] I also texted the ECG to Dr. Smith.

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Chest Pain Blog Arrhythmia Critical Care 64

Dr. Smith's ECG Blog

DECEMBER 20, 2010

Echocardiogram showed an anteroapical wall motion abnormality. This is highly suspicious for acute anterior STEMI. However, she was found to have a fatal pontine hemorrhage and had a maximum troponin I, at 12 hours after presentation, of 2.0

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Cardiomyopathy STEMI Hemorrhage Echocardiogram 52

Dr. Smith's ECG Blog

OCTOBER 6, 2012

In this study of consecutive patients with LBBB who were hospitalized and had an echocardiogram, a QRS duration less than 170 ms (n = 262), vs. greater than 170 ms (n = 38), was associated with a significantly better ejection fraction (36% vs. 24%). Here is a similar case involving right bundle branch block.

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Echocardiogram Hospital 52

BoardVitals - Cardiovascular

MAY 1, 2017

Echocardiogram is indicated (Correct) C. Start aspirin and Plavix Correct answer: (B) (B) Echocardiogram is indicated. The post Hypertropic Cardiomyopathy: A Board Review Question Explained By Video appeared first on BoardVitals Blog. Which of the following is the best statement to describe further clinical management?

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Cardiomyopathy Sudden Cardiac Death Bicuspid/Mitral Electrocardiogram 52

Dr. Smith's ECG Blog

JULY 16, 2022

Here is the post PCI EKG: And a few hours after that: The post PCI echocardiogram showed: Normal estimated left ventricular ejection fraction, 57%. This is a large OMI that has Zero ST Elevation but can be diagnosed by ECG features other than ST Elevation!! Regional wall motion abnormality-mid to basal inferior wall.

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Chest Pain Bradycardia Blog Critical Care 52

Dr. Smith's ECG Blog

MARCH 2, 2009

A stat echocardiogram would have helped to make this diagnosis and facilitate timely reperfusion. Possibilities include: serial ECGs (which were done but still nondiagnostic), stat echocardiogram, or posterior ECG. Pain is similar, but associated with less SOB. Exam is unremarkable.

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Heart attacks Heart Attack STEMI Echocardiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2022

Echocardiogram: The estimated left ventricular ejection fraction is 34% Regional wall motion abnormality-lateral, akinetic. Selected LINKS for More on the Mirror Test: ECG Blog #246 — Reviews the concept of the "Mirror Test" with a clinical example. A massive acute OMI.

Chest Pain 52

Chest Pain Blog Ischemia STEMI 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 Stenosis STEMI 52

GEMMS

SEPTEMBER 12, 2023

These specialized functionalities encompass advanced ECG interpretation, seamless stress test reporting, and the integration of diverse imaging modalities, such as echocardiograms and MRIs. Cardiology-specific EHR software seamlessly integrates data from echocardiograms, MRIs, and other cardiac imaging sources.

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Echocardiogram Reimbursement Patient Care Article 52

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. Bedside echocardiogram showed hypokinesis of the mid to distal anterior wall and apex. Initial hscTnI was 10 ng/L (ref. <14). There was no recommendation for repeat ECG.

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Plaque Stents Stent Chest Pain 67

Dr. Smith's ECG Blog

OCTOBER 22, 2024

The echocardiogram shows a preserved left ventricular ejection fraction (LVEF) of 55% with marked basal and mid inferolateral and basal anterolateral hypokinesia. As we often note in Dr. Smith's ECG Blog — there normally should be slight, upward sloping ST elevation in leads V2 and V3. Good angiographic result.

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Chest Pain STEMI Myocardial Infarction Angioplasty 67

GEMMS

AUGUST 29, 2024

This blog explores the profound benefits of AI and machine learning, which are revolutionizing cardiology practices, enhancing efficiency, and ultimately improving patient care. These technologies are not just reshaping but also empowering how cardiology practices manage operations, deliver care, and enhance patient outcomes.

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Technology Patient Care Outcomes Coronary Artery Disease 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2023

The diagnosis was a bit hard to find in the chart, and the echocardiogram did only stated "assymetric hypertrophy." For MORE on Some of the Concepts I Comment On: Re the ECG findings in HCM ( H ypertrophic C ardio M yopathy ) — See My Comment at the bottom of the page in the October 28, 2023 post in Dr. Smith's ECG Blog.

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Strokes Stroke Chest Pain Cardiomyopathy 70