Cardiogenic Shock Hospital Ischemia 
Dr. Smith's ECG Blog
FEBRUARY 16, 2020
A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Our chief of cardiology, Gautam Shroff, interprets it differently and thinks this is indeed ischemia. Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9,
Dr. Smith's ECG Blog
SEPTEMBER 5, 2024
She presented to an outside hospital after several days of malaise and feeling unwell. The VSR is what is causing the cardiogenic shock! Application to Today's Case: Today's patient developed ventricular septal rupture the evening after she was admitted to the hospital. Heart rate was in the 80s.
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. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).
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.
Dr. Smith's ECG Blog
JUNE 11, 2021
Similarly, STEMI guidelines call for urgent angiography for refractory ischemia or electrical/hemodynamic instability, regardless of ECG findings. So there is now high pre-test probability + refractory ischemia + Modified Sgarbossa + dynamic ECG changes. But by this time the patient went into cardiogenic shock and passed away.
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?
Dr. Smith's ECG Blog
OCTOBER 6, 2023
All of this appears to be consistent with "No Reflow", or small vessel occlusion with persistent ischemia in spite of an open artery. His included cardiogenic shock, V Tach, AV block. He was hospitalized for 16 days. --There is persistent ST elevation in leads V1-V4, with a lot of STE in V4 (another bad sign).
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