Document Ischemia Stent 
Dr. Smith's ECG Blog
JANUARY 9, 2024
The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? The last echocardiography 12 months ago showed HFmrEF.
Dr. Smith's ECG Blog
MARCH 22, 2024
The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible. Back to the assessment of ischemia: Returning to the ECG, the leads that catch my eye first are -- I, II, V4, V5, V6. Ischemia can be disguised by a wide escape rhythm, which decreases the sensitivity of ECG.
Dr. Smith's ECG Blog
MARCH 27, 2025
But it was interpreted as no acute ischemia and the patient was referred to cardiology as Non-STEMI. The total occlusion was recanalized and stented from 100 to 0%. Clinical: patient alerts for refractory ischemia (refractory chest pain), and empowering nurses to advocate for patients 4.
Dr. Smith's ECG Blog
NOVEMBER 15, 2013
The ECG in the chart was read as "no obvious ST changes," (even though no previous ECG was available) and the formal read by the emergency physicians was: "ST deviation and moderated T-wave abnormality, consider lateral ischemia." It is well documented with continuous 12-lead monitoring that acute re-occlusion is frequently asymptomatic.
Dr. Smith's ECG Blog
DECEMBER 27, 2023
The pain will resolve and you will think the ischemia is gone when it is only hidden ! Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Just before 10 AM, the patient received a stent to the culprit OM. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL.
Dr. Smith's ECG Blog
JUNE 28, 2019
60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. It was stented. The patient had a p rior h istory of MI + stents. In this patient with documented coronary disease — these q waves could reflect prior lateral infarction ( especially in view of the Q in lead aVL ).
Dr. Smith's ECG Blog
JULY 11, 2018
He did, found the true culprit, and went back in to stent it. His astute observation is worthy of brief discussion: Rituparna et al document a case study report, in which J waves appeared to be induced by ischemia ( Pacing Clin Electrophysiol 30(6):817-819, 2007 ). You can listen to my explanation by playing the video.
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