Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again. An angiogram is a " lumenogram " and does not "see" the extraluminal plaque.

Plaque 66

Plaque Stents Stent Chest Pain 66

Dr. S. Venkatesan MD

FEBRUARY 25, 2024

It means either a percutaneous coronary intervention with a stent or CABG. You may be. But I am not.You need to undergo some re-vascularisation procedure. What do you mean by that Doctor ? Can I get my heart re-vascularised by drugs alone Doctor ? No we can’t. Hmmm , wait, we do have something called OMT/GDMT.

Chest Pain 59

Chest Pain Plaque Stents Stent 59

Circulation

NOVEMBER 11, 2024

Description of Case:A 64-year-old male with complex medical history, including infective endocarditis of the aortic valve requiring surgical replacement with a bioprosthetic valve and recurrent infective endocarditis of the bioprosthetic valve, presented with two hours of crushing chest pain and found to have ST elevations.

Aortic valve 40

Aortic valve TAVR Chest Pain Aortic 40

All About Cardiovascular System and Disorders

APRIL 17, 2024

CT coronary angiogram is useful to rule out significant blocks in in those presenting with chest pain to the emergency department. But it may not be that useful just to screen for blocks or build-up of plaques in those without any symptoms. Detection of minor plaques in those persons might lead on to undue anxiety.

Coronary Angiogram 40

Coronary Angiogram Catheterization Laboratory Angioplasty Chest Pain 40

Dr. Smith's ECG Blog

JULY 11, 2024

No patient with chest pain should be sent home without troponin testing. A chest x-ray in the ED found bilateral pleural effusions. The scan did not find PE, but showed evidence of coronary plaque: There are areas of dense white in the LAD (red and blue circles) and in the first diagonal (green circle).

Outcomes 112

Outcomes Stenosis Outpatient Echocardiogram 112

Dr. Smith's ECG Blog

MAY 10, 2023

A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JULY 11, 2018

A 40-something woman had sudden chest pain. Today, they viewed the angiogram and concluded that the thrombus at the mid RCA must have extended proximally from the culprit ruptured plaque, extending proximal to the RV marginal branch and temporarily occluding it. He did, found the true culprit, and went back in to stent it.

Chest Pain 52

Chest Pain STEMI Ischemia Blog 52

Dr. Smith's ECG Blog

JULY 31, 2018

The lesion was stented. While ST coving in V1 is not necessarily abnormal — the presence of ST elevation in association with ST-T wave abnormalities in V2,V3 in a patient with chest pain is clearly cause for concern. It seems that there was some uncertainly about this. There is also ST coving and elevation in lead V1.

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

DECEMBER 23, 2022

Opened and stented. Acute MI due to plaque rupture does happen in young people, including young women. Instead, in a patient with new chest pain and hyperacute inferior lead T waves — this picture that we see in lead V3 suggests associated posterior OMI until proven otherwise. Beware a low HEART score.

Chest Pain 52

Chest Pain Critical Care STEMI Plaque 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. It was stented. Echo may be normal ( especially if the patient no longer has chest pain ). Regional wall motion abnormality-distal septum and apex.

STEMI 40

STEMI Chest Pain Hospital Risk Factors 40

DAIC

APRIL 11, 2024

These new findings suggest that people with high-risk plaques that are likely to rupture could benefit from the procedure as a pre-emptive measure rather than waiting for a heart attack or other severe reduction in blood flow to occur. During PCI, an operator inserts a stent into a blocked artery through a catheter in the groin or arm.

Plaque 111

Plaque Heart Attack Heart attacks Coronary Artery Disease 111

DAIC

APRIL 2, 2025

Stone, MD Mount Sinai Health System tim.hodson Wed, 04/02/2025 - 15:26 March 31, 2025 Using intravascular imaging (IVI) to guide stent implantation during complex stenting procedures is safer and more effective for patients with severely calcified coronary artery disease than conventional angiography, the more commonly used technique.

Stents 40

Stents Stent Outcomes Coronary Angiogram 40

Dr. Smith's ECG Blog

JUNE 23, 2024

Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. He did not remember whether he had experienced any chest pain. (TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Two subsequent troponins were down trending.

Chest Pain 118

Chest Pain Cardiac Arrest Sudden Cardiac Death Blog 118

Dr. Paddy Barrett

DECEMBER 5, 2023

The logic of stenting obstructed coronary arteries is simple. A stent unblocks the artery. Subscribe now Stenting stable coronary artery disease has not been convincingly proven to reduce the risk of future heart attacks or death 1. But coronary stenting is not the only way to reduce symptoms of angina. All is fixed.

Stents 59

Stents Stent Angina Heart Attack 59

Dr. Paddy Barrett

NOVEMBER 28, 2023

One of the most common questions I get is, “ Do I need a stent to treat my heart disease?” ” Typically, several of this person’s friends have had stents, so it seems natural to ask. First, we must understand what a stent is and why it is used. The stent ‘unblocks’ it. Flow is restored.

Stents 53

Stents Stent Heart Attack Heart attacks 53

Dr. Paddy Barrett

AUGUST 1, 2023

A CTCA provides much more anatomical detail and can identify advanced plaque often missed by CT Coronary Artery Calcium Score scans alone. Share Chest Pain Symptoms There is no role for CT Calcium Scoring in the setting of someone with chest pain symptoms suspected to be from a narrowed coronary artery.

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Smith's ECG Blog

MARCH 9, 2017

Case A 42-year-old lady presented to the ED with complaints of intermittent episodes of chest pain associated with shortness of breath for the last 2 days. This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. This case was written by Sam Ghali: ( @EM_RESUS ). Normal ECG.”

Chest Pain 52

Chest Pain Angina Ischemia Plaque 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. It was stented. As there was ruptured plaque, this is NOT Prinzmetal's angina. It is just as dangerous, as there is a ruptured plaque with thrombus (which lysed) in the proximal LAD. Values: STE60V3 = 2.0, QRS V2 = 10, RAV4 = 15.5, Thelin et al.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

MARCH 19, 2025

Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. Influenza-like illness can also trigger plaque rupture.

Chest Pain 116

Chest Pain STEMI Stents Stent 116

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. or 2) Inferior and lateral OMI that is beginning to reperfuse, even though the patient still has chest pain? ECG 1 What do you think?

Chest Pain 109

Chest Pain Ischemia Stents Stent 109

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Written by Willy Frick A young woman with a history of paroxysmal nocturnal hemoglobinuria presented with acute substernal chest pain. The report describes heavy plaque in the proximal RCA by IVUS, but no lesions in the previously occluded RPL branch and no stent was deployed. Smith : The cath lab should be activated now!

Chest Pain 66

Chest Pain Hospital Anatomy Aneurysm 66

Dr. Smith's ECG Blog

MARCH 1, 2025

A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. He reports this was similar to how he felt when he had his heart attack 4 years prior, now s/p 4 stents. The chest pain continued for hours. The patient was still having chest pain.

Chest Pain 121

Chest Pain STEMI Stents Stent 121

Dr. Smith's ECG Blog

MARCH 25, 2025

Written by Willy Frick A woman in her 60s with very severe hyperlipidemia (LDL >200 mg/dL) presented with acute onset chest pain. She described the pain as moderate in severity, and said it had come and gone several times over the next few hours before ultimately resolving. Her symptoms began while getting off the bus.

Chest Pain 63

Chest Pain Ischemia Plaque Stents 63

Dr. Smith's ECG Blog

MARCH 8, 2025

After stent deployment, we often see improvement in the ST-T within seconds or minutes. Here is the final angiogram following placement of a stent in the ostial RCA. 2:04 PM, post stent deployment You can see that even after complete restoration of flow, the ECG still looks terrible, V most of all.

Cardiomyopathy 75

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75