Coronary Artery Disease, Hypertension and STEMI

Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

Dr. Smith's ECG Blog

JANUARY 27, 2024

Old ‘NSTEMI’ A history of coronary artery disease and a stent to the same territory further increases pre-test likelihood of acute coronary occlusion, including in-stent thrombosis. So this NSTEMI was likely a STEMI(-)OMI with delayed reperfusion. Deutch et al.

Chest Pain

Chest Pain STEMI Aneurysm Stents

Construction and validation of a predictive model for major adverse cardiovascular events in the long term after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Coronary Artery Disease Journal

APRIL 24, 2024

Purpose Construction of a prediction model to predict the risk of major adverse cardiovascular events (MACE) in the long term after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).

Myocardial Infarction

Myocardial Infarction STEMI Diabetes Hypertension

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. Incidence of an acute coronary occlusion.

Ischemia

Ischemia STEMI Stenosis Chest Pain

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Distractions

EMS 12-Lead

MARCH 19, 2023

Vital signs were noted to be unremarkable with respect to any hypo-hypertensive crisis, hypoxia, etc. He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. No appreciable skin pallor.

Myocardial Infarction

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

The British Journal of Cardiology

APRIL 16, 2024

Comorbidities included dyslipidaemia 515/567 (90.9%), hypertension 460/567 (81.2%), diabetes 346/567 (61%), known prior coronary disease 250/567 (44.2%), and smoking 188/567 (33.1%).

Outcomes

Outcomes Cardiogenic Shock Angina STEMI

The Computer and Overreading Cardiologist call this completely normal. Is it?

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. At 2111, the troponin I peaked at 12.252 ng/mL (this is in the range of STEMI patients, quite high).

Chest Pain

Chest Pain Blog Hospital Coronary Artery Disease

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain. A mid 60s woman with history of hypertension, hyperlipidemia, and GERD called 911 for chest pain. An apical OMI has the same ultrasound findings as takotsubo, and thus mimics takotsubo. Lindahl et al.

Plaque

Plaque Chest Pain Thrombosis Stenosis

A "normal ECG" on a busy night

Dr. Smith's ECG Blog

OCTOBER 6, 2018

The patient was in his 50s with history of hypertension, diabetes, seizure disorder, and smoking, but no known coronary artery disease. He wrote in his note that "The EKG showed early repolarization in I, V2-V3 but no clear STEMI pattern." 418 of these 1788 (23%) had acute coronary occlusion.

Chest Pain

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease

A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

The patient stated he had a long history of well-controlled hypertension for which he was compliant with his ACE-inhibitor. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused.

Chest Pain

Chest Pain Pulmonary ACE Inhibitor STEMI

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. What do you see?

Ischemia

Ischemia Cardiogenic Shock Aortic Stenosis

Diffuse ST depression, and ST elevation in aVR. Left main, right?

Dr. Smith's ECG Blog

MARCH 2, 2019

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Does this patient have hypertension and/or heart failure that has worsened? This might be a common scenario given this patients demographics and his underlying disease ).

Sickle Cell Disease

Sickle Cell Disease Ischemia Chest Pain Dysrhythmia

The effect of gender on clinical outcomes following routine revascularizations with polymer-free sirolimus-eluting stents

Coronary Artery Disease Journal

NOVEMBER 20, 2023

Data were pooled and analyzed in terms of clinical outcomes to assess the impact of gender in patients with stable coronary artery disease and acute coronary syndrome. After propensity-score-matching, primarily adjusting for age, hypertension and diabetes, our data revealed similar accumulated MACE in women and men (5.5%

Stents

Stents Stent Outcomes Coronary Artery Disease

A 50-something with chest pain.

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria). He reports feeling nauseated with emesis.

Chest Pain

Chest Pain Defibrillator STEMI Coronary Artery Disease

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

A middle-aged woman with history of hypertension presented to another hospital approximately 2 hours after onset of chest pain and shortness of breath. This is technically a STEMI, with 1.5 However, I think many practitioners might not see this as a clear STEMI, and would instead call this "borderline." mm STE in V1 and 1.5-2.0

STEMI

STEMI Chest Pain Ischemia Myocardial Infarction

The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Coronary Artery Disease Journal

NOVEMBER 1, 2023

However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI. Methods The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention.

Myocardial Infarction

Myocardial Infarction Hospital STEMI Cancer

Should we wait for troponin when the ECG does not show "diagnostic" ST Elevation?

Dr. Smith's ECG Blog

JANUARY 24, 2025

Written by Willy Frick A 52 year old man with hypertension, dyslipidemia, and seropositive rheumatoid arthritis (a risk factor for CAD) presented with acute substernal chest pressure with diaphoresis which woke him from sleep just after midnight. He said it felt like "someone ripped [his] heart out." But that is not what happened.

Chest Pain

Chest Pain STEMI Risk Factors Coronary Artery Disease

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. Truly, the Marquette 12 SL algorithm correctly identifies this STEMI.

Tachycardia

Tachycardia Pulmonary Chest Pain Stenosis

Sex differences in ST-segment elevation myocardial infarction patients treated by primary percutaneous intervention

Open Heart

JANUARY 4, 2025

Introduction The impact of sex on coronary artery disease prognosis is debated. We aim to investigate the influence of sex on the timing and clinical outcomes of ST-segment elevation myocardial infarction (STEMI) patients using a controlled Swiss registry. Disparities are more related to patient characteristics than sex.

Myocardial Infarction

Myocardial Infarction STEMI Coronary Artery Disease Outcomes

Cardiovascular Update

Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

Construction and validation of a predictive model for major adverse cardiovascular events in the long term after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Webinars

Distractions

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

The Computer and Overreading Cardiologist call this completely normal. Is it?

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

A "normal ECG" on a busy night

A man in his 70s with chest pain during a bike ride

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Diffuse ST depression, and ST elevation in aVR. Left main, right?

The effect of gender on clinical outcomes following routine revascularizations with polymer-free sirolimus-eluting stents

A 50-something with chest pain.

What will you do for this patient transferred to you who is now asymptomatic?

The prognostic importance of the Naples prognostic score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Should we wait for troponin when the ECG does not show "diagnostic" ST Elevation?

Pulmonary edema, with tachycardia and OMI on the ECG -- what is going on?

Sex differences in ST-segment elevation myocardial infarction patients treated by primary percutaneous intervention

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