Echocardiogram, Ischemia and Pulmonary

Infection and DKA, then sudden dyspnea while in the ED

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Xray was consistent with pulmonary vascular congestion. 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? That this is all demand ischemia is unlikely.

Chest Pain

Chest Pain Ischemia Echocardiogram Myocardial Infarction

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Chronic Pulmonary Disease Lung diseases like chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension, which in turn can cause the right side of the heart to enlarge, a condition known as cor pulmonale.

Blood Pressure

Blood Pressure Blood Clot Heart Valves Heart Rhythm

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

JANUARY 2, 2025

CT of the chest showed no pulmonary embolism but bibasilar infiltrates. It should be kept in mind that on occasions, beta-one agonist can result in increased ventricular ectopy e.g., in severe myocardial ischemia (by increasing myocardial demand), or sometimes with congenital long-QT syndrome. She was intubated. J Am Coll Cardiol.

Tachycardia

Tachycardia Cardiomyopathy Blog Bradycardia

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

A transthoracic echocardiogram showed an LV EF of less than 15%, critically severe aortic stenosis , severe LVH , and a small LV cavity. The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed. As with other cases of shock, initial fluid resuscitation may be considered.

Ischemia

Ischemia Cardiogenic Shock Aortic Stenosis

Abstract 4119267: Diagnosing An Uncommon Presentation of Cardiac Sarcoidosis with Isolated Bi-Atrial Involvement: A Case Report

Circulation

NOVEMBER 11, 2024

Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chest pain for 2 months. EKG, cardiac enzymes, and Initial echocardiogram(TTE) was unremarkable. The enhancement raised suspicion for CS.

Chest Pain

Chest Pain Echocardiogram Document Ischemia

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Hopefully a repeat echocardiogram will be performed outpatient. Q waves in association with RBBB are usually not seen in anterior leads unless there is pulmonary hypertension or anterior infarction.

Tachycardia

Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia

Profound ST depression in II, III, aVF

Dr. Smith's ECG Blog

JULY 27, 2023

hours ECG: Not much change hs troponin I peaks at 500 ng/L 8 hours Next morning Urine drug screen: Amphetamine, Methamphetamine, Fentanyl, Fentanyl metabolite Formal Bubble Contrast Echocardiogram: Indications for Study: Silent Ischemia. The estimated pulmonary artery systolic pressure is 29 mmHg + RA pressure.

Tachycardia

Tachycardia Ischemia Cardiac Arrest Echocardiogram

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

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

These findings are concerning for inferior wall ischemia with possible posterior wall involvement. Unfortunately there is no echocardiogram accessible because the patient checked himself out of the hospital in order to get back to his home state before it could be completed. No significant changes, ongoing pain.

Chest Pain

Chest Pain Pulmonary ACE Inhibitor Pacemaker

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. Of the 67 patients who underwent targeted tests, suspected diagnoses were confirmed in 49 (73%) patients: aortic stenosis (n = 8, 1%), pulmonary embolism (n = 8, 1%), seizures/stroke (n = 30, 5%), and other diseases (n = 3). Left BBB vi. Pathologic Q-waves viii. LVH or RV d.

Arrhythmia

Arrhythmia Outcomes Chest Pain Risk Factors

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

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

Tachycardia Pulmonary Chest Pain Stenosis

Are there hyperacute T-waves? And how can we know?

Dr. Smith's ECG Blog

DECEMBER 6, 2024

Watch what happends as the heart recovers from its episode of ischemia. Case continued Troponins over 26 hours, from right to left : Echocardiogram: Mild concentric left ventricular wall thickening, normal cavity size, and normal systolic function. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute?

Coronary Artery Bypass Graft

Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis

Acute Dyspnea in a Dialysis Patient. K is 6.3 mEq/L. Are ECG findings due to hyperkalemia, or even due to Type 2 MI?

Dr. Smith's ECG Blog

JANUARY 21, 2025

Bedside POCUS showed very poor LV function and a few pulmonary B lines. A Chest X-ray did not show pulmonary edema. Time 7 hours lead reversal There is limb lead reversal (QRS in I and aVL are now inverted), but nevertheless one can see that the ischemia appears to have resolved. He was put on BiPAP. Next day, with K = 4.6

Chest Pain

Chest Pain STEMI Tachycardia Myocardial Infarction

Case Report: Anomalous origin of the right coronary artery leading to cardiac arrest induced by sexual activity: a previously unreported pathogenetic condition

Frontiers in Cardiovascular Medicine

NOVEMBER 28, 2024

The clinical significance of ARCA-LCS lies in its potential to cause myocardial ischemia or sudden cardiac death, particularly under physical exertion. Transthoracic echocardiogram, bilateral carotid Doppler ultrasound, and electrocardiogram were normal. No previous history of hypertension or diabetes.

Cardiac Arrest

Cardiac Arrest Sudden Cardiac Death Electrocardiogram Echocardiogram

Cardiovascular Update

Infection and DKA, then sudden dyspnea while in the ED

Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment

Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Webinars

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

Abstract 4119267: Diagnosing An Uncommon Presentation of Cardiac Sarcoidosis with Isolated Bi-Atrial Involvement: A Case Report

A teenager involved in a motor vehicle collision with abnormal ECG

Profound ST depression in II, III, aVF

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

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

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

Are there hyperacute T-waves? And how can we know?

Acute Dyspnea in a Dialysis Patient. K is 6.3 mEq/L. Are ECG findings due to hyperkalemia, or even due to Type 2 MI?

Case Report: Anomalous origin of the right coronary artery leading to cardiac arrest induced by sexual activity: a previously unreported pathogenetic condition

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