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What do you think the echocardiogram shows in this case?

Dr. Smith's ECG Blog

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. What do you think the echocardiogram shows? NTG drip started. Pain better still.

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Infection and DKA, then sudden dyspnea while in the ED

Dr. Smith's ECG Blog

Important point: when there is diffuse subendocardial ischemia but no OMI, a wall motion abnormality will not necessarily be present. See this post: What do you think the echocardiogram shows in this case? They agreed ischemia was likely in the setting of demand given DKA and infection. 40 mg of furosemide was given.

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ECG Blog #412 — Is Cardiac Cath Indicated?

Ken Grauer, MD

My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation." BOTTOM LINE: ECG changes of LV "strain" and/or ischemia that we see on today's initial ECG — were not present 9 years earlier. Cardiac cath showed normal coronary arteries.

Blog 158
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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity. 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.

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Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Dr. Smith's ECG Blog

There is profound LVH with anterolateral ST elevation and reciprocal ST depression in II, III, aVF, and ST depression in V5 and V6 that could all be secondary to LVH or could represent ischemia superimposed on the repolarization abnormalities of LVH: note that wherever there is ST depression, it is associated with a very high voltage R-wave.

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Epigastric and Right Upper Quadrant pain after eating spicy food

Dr. Smith's ECG Blog

There is akinesis of the distal septum, anterior, apex, and distal inferior wall consistent with LAD territory ischemia or infarction. Echocardiography: Normal left ventricular size with mild to moderately reduced LV systolic function; estimated LVEF is 44 %. How large is the infarct? Probably significant infarction.

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This ST segment is trying to confuse us

Dr. S. Venkatesan MD

The fact that the heart rate is normal rules out demand side ischemia as well. She needs an echocardiogram to rule out any subclinical myocardial disease. Echocardiogram is a must. Very likely, it should be LVH or anemia or some other systemic medical conditions. Have seen a HCM variants like this ).TMT Reference 1.