Remove Echocardiogram Remove Ischemia Remove Stents
article thumbnail

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.

article thumbnail

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.

article thumbnail

VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

This was interpreted by the treating clinicians as not showing any evidence of ischemia. Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. Echocardiogram showed LVEF 66% with normal wall motion and normal diastolic function.

article thumbnail

Three prehospital ECGs in patients with chest pain

Dr. Smith's ECG Blog

In any case, the ECG is diagnostic of severe ischemia and probably OMI. So this could be myocarditis but in my opinion needs an angiogram before making that diagnosis. == Dr. Nossen Comment/Interpretation: Evaluation of ischemia on an ECG can be very challenging. Concordant STE of 1 mm in just one lead or 2a.

article thumbnail

Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. Whether these EKGs show myocarditis, a normal variant, or something else, they are overall not typical of transmural ischemia of the anterior or high lateral walls. It was stented.

article thumbnail

Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

Total proximal LAD occlusion was found and stented at angiography soon after the ECG above. The other challenge posed by the ECG of a patient with marked LVH with "strain" is distinguishing between the ST-T wave inversion in one or more lateral leads due solely to LVH vs that due to acute ischemia or infarction.

article thumbnail

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

A stent was placed. For those who depend on echocardiogram to confirm the ECG findings of ischemia, this should be sobering. In this case, the duration of ischemia was so brief that there was no such evolution, and there was near-normalization. Ischemia may be so brief that Wellens' waves do not evolve 3.