Dr. Smith's ECG Blog

NOVEMBER 19, 2016

A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity. The aortic valve in this example also had critical stenosis by Doppler The patient continued to be hemodynamically unstable with poor cardiac output and very high LV filling pressures.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

He was taken rapidly to the cath lab and here are some representative images before and after intervention: Acute proximal LAD culprit with TIMI 0 flow, 100% stenosis, thrombotic occlusion, requiring thrombectomy and PCI. Post cath EF was estimated at 15% with severe global hypokinesis, and akinesis of the apex.

Chest Pain 122

Chest Pain STEMI Cardiogenic Shock Heart Failure 122

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

COPD, Idiopathic PAH, acute or chronic PE, pulmonary valve stenosis, etc) 3) Conditions affecting RV myocardial contractility, such as ARVD or RV infarction The ECGs does not really show any signs of chronic RV dilation or hypertrophy. Any cause of pulmonary hypertension. Our THANKS to Dr. Magnus Nossen for sharing this case with us.

Pulmonary 118

Pulmonary Tricuspid Chest Pain Cardiogenic Shock 118

DAIC

FEBRUARY 29, 2024

24: Joint American College of Cardiology/Journal of the American College of Cardiology Late-Breaking Clinical Trials (Session 402) Saturday, April 6 9:30 – 10:30 a.m.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

EMS 12-Lead

JULY 24, 2023

Category 2 : An increase in myocardial oxygen demand due to tachycardia, elevated ventricular afterload (BP or aortic stenosis), or increased wall stretch (admittedly this latter is more complicated) or a decrease in oxygen supply due to hypotension, anemia, hypoxia, or a combination of all of the above. Aortic Stenosis f.

Angina 52

Angina Ischemia Coronary Angiogram Stenosis 52

Dr. Smith's ECG Blog

APRIL 24, 2020

Just prior to transport, the patient became confused and agitated and, although blood pressure and pulse were OK, I was worried about cardiogenic shock. Angiogram Left main: Severe calcific stenosis of ostial and distal left main. LAD: large caliber vessel with severe calcific stenosis of the proximal LAD with TIMI2 flow.

Ischemia 52

Ischemia Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JUNE 19, 2023

The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. Angiogram showed a culprit lesion of 100% stenosis to the right coronary artery and 100% stenosis of the right posterior descending artery, both with TIMI 0 flow.

Chest Pain 52

Chest Pain STEMI Cardiogenic Shock Bradycardia 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Left main?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

61,62) The interventional community defines occlusive LM disease as >50% by FFR, or ≥75% stenosis,(63) but urgent or emergent intervention on lesions not meeting these thresholds is only imperative if it is a thrombotic lesion and the patient has refractory ischemic symptoms (i.e. TIMI 0/1 flow).(61,62) Knotts et al.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

Why is the patient in shock? He was in profound cardiogenic shock. He was taken to the cath lab and underwent emergent intervention: Thrombotic stenosis of the proximal RCA (95% with evidence of plaque rupture) is the culprit for the patient's inferoposterior STEMI. There is an obvious inferior STEMI, but what else?

Bradycardia 40

Bradycardia Cardiogenic Shock STEMI Ischemia 40

Dr. Smith's ECG Blog

MAY 8, 2023

So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"!

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). In addition, the top left blue arrow indicates a section in the LAD with a severe stenosis, likely the culprit for the prior L A D occlusion which has since recanalized. There are also diagonal branches which are not well visualized.

Chest Pain 65

Chest Pain Blog Arrhythmia Critical Care 65

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Adult Cardiac Surgery Database Lead Author Title Publication Date Jacob Raphael Red Blood Cell Transfusion and Pulmonary Complications: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis The Annals of Thoracic Surgery January 2024 Joseph Sabik Multi-Arterial versus Single-Arterial Coronary Surgery: Ten Year Follow-up of One Million (..)

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Institutional Coronary Artery Bypass Case Volumes and Outcomes European Journal of Heart Failure October 2023 Makoto Mori 1 Robotic Mitral Valve Repair for Degenerative Mitral Regurgitation The Annals of Thoracic Surgery August 2023 Carlos Diaz-Castrillion 2 Volume-Failure to Rescue Relationship in Acute Type A Aortic Dissections: An Analysis of The (..)

Research 52

Research Coronary Artery Bypass Graft Aortic valve Congenital 52

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. Smith : "decompensation" of aortic stenosis might have initiated this entire cascade. What "initiates" the aortic stenosis cascade? We certainly know that there is hypoxia.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. S. Venkatesan MD

JANUARY 1, 2025

Top 10 Clinical Trials Preventive PCI on Stenosis With Functionally Insignificant Vulnerable Plaque PREVENT (ACC.24) 24) Microaxial Flow Pump in Infarct-Related Cardiogenic Shock DanGer Shock (ACC.24) Top 10 Clinical Trials Preventive PCI on Stenosis With Functionally Insignificant Vulnerable Plaque PREVENT (ACC.24)

Cardiogenic Shock 59

Cardiogenic Shock Plaque Academic Bicuspid/Mitral 59