Dr. Smith's ECG Blog

JANUARY 2, 2025

Finally, do a coronary angiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. This usually done by a pacer lead placed through the coronary sinus (LV venous system). Use Lidocaine instead (lidocaine prevents the PVCs which cause R on T, and does not prolong the QT.)

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

Dr. Smith's ECG Blog

MAY 20, 2024

This EKG is diagnostic of transmural ischemia of the inferior wall. If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. Smith comment 2: I frequently see failure to control BP in patients with acute chest pain or acute heart failure.

Chest Pain 125

Chest Pain Blood Pressure Ischemia STEMI 125

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 ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

EMS 12-Lead

MAY 20, 2022

There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

He was transitioned to oral heart failure medications and discharged home slightly over one week after presentation. He was readmitted a few weeks later for a heart failure exacerbation, diuresed, and discharged again. The last information available is that the patient was undergoing heart transplant evaluation.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

MARCH 3, 2025

Anything that causes pulmonary edema: poor LV function, fluid overload, previous heart failure (HFrEF or HFpEF), valvular disease. The patient was started on heparin for possible NSTEMI vs demand ischemia. increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.)

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73