Cardiology Update

APRIL 30, 2024

The highly impactful International Study of Comparative Health Effectiveness With Medical and Invasive Approaches ( ISCHEMIA ) trial investigated the effectiveness of invasive (INV) versus conservative (CON) strategies for managing stable coronary artery disease. Original article: Gaudino M et al. EuroIntervention.

Coronary Artery Disease 119

Coronary Artery Disease Ischemia Outcomes Cardiac Arrest 119

DAIC

JANUARY 23, 2024

Atherosclerotic cardiovascular disease (ASCVD), caused by plaque buildup in arterial walls, is one of the leading causes of disability and death worldwide.1,2 1,2 ASCVD causes or contributes to conditions that include coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease (inclusive of aortic aneurysm).3

Cardiovascular Disease 111

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Paddy Barrett

AUGUST 1, 2023

CT coronary angiography, in addition to a CT CAC, is arguably the best test for estimating whether someone has evidence of coronary artery disease and what that means for their near-term risk of a heart attack. 2 Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. Medicine (Baltimore).

Coronary Angiogram 52

Coronary Angiogram Plaque Coronary Artery Disease Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

Ischemia 52

Ischemia STEMI Stenosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Detailed coronary artery evaluation not performed. This suggests further severe ischemia.

Coronary Angiogram 103

Coronary Angiogram Plaque Thrombosis STEMI 103

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging.

Chest Pain 103

Chest Pain Ischemia Pacemaker Stents 103

Dr. Anish Koka

MAY 16, 2023

Diamond and Forrester accomplished this by first establishing the prevalence of coronary artery disease based on how clinically likely patients with chest pain symptoms were found to have coronary disease based on a coronary angiogram. Thanks for reading Dr. Anish Koka's Newsletter! This happens.

Chest Pain 52

Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

JULY 21, 2024

Troponin T peaked at 38,398 ng/L ( = a very large myocardial infarction, but not massive-- thanks to the pre-PCI spontaneous reperfusion, and rapid internvention!! ). There is no definite evidence of acute ischemia. (ie, Some residual ischemia in the infarct border might still be present.

Arrhythmia 116

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 116

Journal of the American Heart Association

FEBRUARY 27, 2024

We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. Women had less coronary artery disease: multivessel in 60.0%

Ischemia 45

Ischemia Coronary Artery Disease Myocardial Infarction Outcomes 45

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Important point: when there is diffuse subendocardial ischemia but no OMI, a wall motion abnormality will not necessarily be present. They agreed ischemia was likely in the setting of demand given DKA and infection. That this is all demand ischemia is unlikely. Lung exam showed diffuse B lines bilaterally. Aslanger's pattern.

Chest Pain 105

Chest Pain Ischemia Echocardiogram Myocardial Infarction 105

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. DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR.

Ischemia 52

Ischemia Cardiogenic Shock Aortic Stenosis 52

Cardiometabolic Health Congress

MAY 10, 2024

In a study published by the American Heart Association, “Sex and Age Differences in the Association of Depression With Obstructive Coronary Artery Disease and Adverse Cardiovascular Events,” researchers investigated 3,237 patients (35% women) undergoing coronary angiography to evaluate for coronary artery disease (CAD).

Coronary Artery Disease 59

Coronary Artery Disease Obesity Chest Pain Ischemia 59

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Such cases are classified as MINOCA (Myocardial Infarction with Non-Obstructed Coronary Arteries).

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Here I explain: First, you don't know for certain what the state of the artery was at the time of the ECG.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. So what will you do for this patient? They found an acute, total, thrombotic occlusion of the proximal LAD. They opened it. Patel et al.,

STEMI 52

STEMI Chest Pain Myocardial Infarction Ischemia 52

Wellnest

DECEMBER 11, 2023

HIV and Cardiovascular Disease: HIV infection itself is associated with an increased risk of cardiovascular disease and can double the risk of CVDs, including myocardial infarction and stroke. Plus, abacavir, an NRTI, has been linked to an increased risk of myocardial infarction.

Quality of Life 52

Quality of Life Myocardial Infarction Public Health Arrhythmia 52

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. If the patient had been "lucky," his symptoms from the prior day might have been due to ischemia prolonged and intense enough to result in small troponin increase. From AM et al.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 52

EMS 12-Lead

APRIL 28, 2022

In most cases, rather, the culprit is gross ischemia due to myocardial infarction, cardiomyopathy, or advanced coronary artery disease. Unfortunately, today’s case is lacking any such diagnostics, thus I cannot say with certainty that the QT interval is, or is not, culpable in arrhythmogenesis. [1]

Tachycardia 52

Tachycardia AFIB Coronary Artery Bypass Graft Arrhythmia 52