Dr. Smith's ECG Blog

MAY 30, 2024

Will you accept this patient for emergent coronary angiogram based on the ECG changes? ischemia) or it can be secondary to abnormal depolarization (e.g Discussion: The ECG in today's case does not have typical ST depression vector of diffuse subendocardial ischemia. How would you interpret the ST changes seen in this ECG?

Ischemia 88

Ischemia Coronary Angiogram Pulmonary STEMI 88

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. Transmural ischemia (as seen with the OMI findings on ECG) is not very common with demand ischemia, but is possible.

Chest Pain 125

Chest Pain Blood Pressure Ischemia STEMI 125

Dr. Smith's ECG Blog

JANUARY 2, 2025

CT of the chest showed no pulmonary embolism but bibasilar infiltrates. Finally, do a coronary angiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. Dobutamine is an acceptable alternative.

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

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 patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

JANUARY 9, 2023

CT angiogram chest: no aortic dissection or pulmonary embolism. Serial chest xrays: progressive bilateral pulmonary edema. Only after her troponin peaked at 500,000 ng/L did she get her angiogram, which showed a 100% left main occlusion due to ruptured plaque. No further troponins were measured.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

MARCH 3, 2025

I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. 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.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73