Dr. Smith's ECG Blog

OCTOBER 18, 2023

4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6] Other signs of OMI that complement the ECG include new regional wall motion abnormalities and refractory ischemia References 1.

Chest Pain 119

Chest Pain STEMI Electrocardiogram Ischemia 119

EMS 12-Lead

APRIL 21, 2022

There is appreciable STE aVR with near-global STD that appropriately maximizes in Leads II and V5, and thus suggesting a circumstance of generic, diffusely populated, circumferential subendocardial ischemia versus occlusive coronary thrombus. [1] There is evolution from Wellens Pattern A to Pattern B, now inclusive of V6.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Wellnest

DECEMBER 21, 2022

An electrocardiogram is a machine used to record the heart's electrical activity. Electrocardiogram, echocardiogram, and some other tests are done for patients with cardiac arrest. Poor blood supply Ischemia, or inadequate blood supply to the heart, is an abnormality that can be detected in an ECG test.

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Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Segment Elevation Myocardial Infarction [link] Abstract Current ST-segment elevation myocardial infarction (STEMI) guidelines require persistent electrocardiogram ST-segment elevation, cardiac enzyme changes, and symptoms of myocardial ischemia.

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Chest Pain STEMI Myocardial Infarction Hospital 107

All About Cardiovascular System and Disorders

APRIL 13, 2024

ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due to transmural ischemia of the basal part of the septum. Value of the electrocardiogram in localizing the occlusion site in the left anterior descending coronary artery in acute anterior myocardial infarction. J Am Coll Cardiol.

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Stenosis Coronary Artery Bypass Graft Coronary Artery Disease Document 52

Dr. Smith's ECG Blog

DECEMBER 22, 2023

The patient with no prior cardiac history presented in the middle of the night with acute chest pain, and had this ECG recorded during active pain: I did not see any ischemia on this electrocardiogram. It does not look entirely normal, since there are some nonspecific STT abnormalities, such as flattening of the T waves in aVL.

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Chest Pain Bradycardia Blog Electrocardiogram 102

Dr. Smith's ECG Blog

JANUARY 1, 2024

An initial electrocardiogram (ECG) is provided below. Learning Point: Concordant ST segment elevation can arise from profound ischemia triggered by ventricular tachycardia (VT), or it may represent an exaggerated basal ST change accompanying tachycardia. The patient was promptly admitted to the hospital for further evaluation.

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Tachycardia Heart Failure Ischemia Blog 96

Dr. Smith's ECG Blog

APRIL 18, 2024

5] Back to the case The patient had serial ECGs over the next hour with no significant change: The first troponin came back at 1,400 ng/L (normal <26 in males and <16 in females), confirming MI – and the patient’s refractory ischemia indicated this was an Occlusion MI. Clin Cardiol 2022 4. Herman, Meyers, Smith et al.

STEMI 118

STEMI Chest Pain Myocardial Infarction Stents 118

EMS 12-Lead

MAY 20, 2022

There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This is the initial ECG: The QRS is widened with a regular cadence, and there are no discernable P waves.

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Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

EMS 12-Lead

APRIL 8, 2022

When “spot diagnosing” precordial ST-depression I instinctively evaluate aVR for any corresponding ST-elevation to see if an emerging pattern of broad subendocardial ischemia can be appreciated, in which the ST-depression should be otherwise global and demonstrably maximal in Leads II and V5. ST-elevation, etc.) is present. 5] Meyers, H.

Myocardial Infarction 52

Myocardial Infarction Coronary Angiogram STEMI Ischemia 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. But the real question at hand is: Are these precordial ST-depressions a result of subendocardial ischemia?

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

MAY 8, 2023

EKG shown here: LAFB with no clear signs of OMI or ischemia. Interestingly, this patient was seen in the ED for hypertension and headache 3 days earlier. No labs were performed. EKG and CT head were performed. Imaging was negative and he was discharged home.

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Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

The stress electrocardiogram is non-diagnostic. This ST-T wave appearance in the lateral chest leads of ECG #2 is consistent with L V “ S train” vs ischemia. No wall motion abnormality at rest. No wall motion abnormality with stress. Next day, a stress echo was done: The exercise stress echocardiogram is normal.

Chest Pain 52

Chest Pain Ischemia Angina Electrocardiogram 52

DAIC

JUNE 25, 2024

The Kardia 12L ECG System, featuring a game-changing patented technology, is the world’s first AI-powered handheld 12-lead electrocardiogram ( ECG ) system with a unique single-cable design. This is the world’s first AI that can detect life-threatening cardiac conditions, including heart attacks, using a reduced leadset.

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Technology Heart Attack Heart attacks Innovation 116

Dr. Smith's ECG Blog

DECEMBER 27, 2018

A Deep Neural Network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation. This ECG comes from Pierre Taboulet ( [link] /)( [link] ) an ECG whiz who codes a lot of ECGs for Cardiologs' Artificial Intelligence Deep Neural Network algorithm ( [link] ). What an honor.

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Chest Pain Hypertension STEMI Heart Disease 52

Dr. Smith's ECG Blog

MARCH 11, 2016

More likely, the patient had crescendo angina, with REVERSIBLE ischemia for 48 hours that only became potentially irreversible (STEMI) at that point in time. During the 48 hours of angina, such reversible ischemia often leads to myocardial stunning with akinesis of the myocardial wall that puts it at risk for thrombus.

Myocardial Infarction 52

Myocardial Infarction Pericarditis Angina STEMI 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?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

DECEMBER 15, 2023

In other words, the inferior ST segments in the first ECG show more straightening which is more concerning for ischemia. Below is the post -PCI electrocardiogram. Most notably the ST depression in the inferior leads is slightly more upsloping. The QoH interpretation however was the same for both ECGs.

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Chest Pain Blog Risk Factors Ischemia 62

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

Integrating ECG Testing to identify cardiometabolic changes and measure the risk of CVD Electrocardiogram Machines like , Wellnest 12L Pro2 serve as a valuable tools in this endeavor, offering a window into the intricate relationship between ART and cardiovascular health. ECGs can identify these abnormalities, enabling timely intervention.

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Quality of Life Myocardial Infarction Public Health Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 5, 2022

Electromechanical association: a subtle electrocardiogram artifact. Arterial pulse tapping artifact [link] This online article references the article below by Emre Aslanger, a great guy who occasionally corresponds with me about ECGs. Aslanger E, Yalin K. Journal of Electrocardiology. 2012;45(1):15-17. doi:10.1016/j.jelectrocard.2010.12.162.

Article 52

Article Circulation Chest Pain Electrocardiogram 52

Dr. Smith's ECG Blog

JULY 22, 2023

Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Heart Rhythm, 13(7): 1515-1520. [2]: 2]: Junttila MJ, Gonzalez M, Lizotte E, Benito B, Vernooy K, Sarkozy A, Huikuri HV, Brugada P, Brugada J, Brugada R. Circulation, 117, 1890–1893. [3]: Brugada electrocardiographic pattern induced by fever.

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Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 67

Dr. Smith's ECG Blog

JANUARY 30, 2019

Induced Brugada-type electrocardiogram, a sign for imminent malignant arrhythmias. Heart Rhythm, 13(7): 1515-1520. [2]: 2]: Junttila MJ, Gonzalez M, Lizotte E, Benito B, Vernooy K, Sarkozy A, Huikuri HV, Brugada P, Brugada J, Brugada R. Circulation, 117, 1890–1893. [3]: Brugada electrocardiographic pattern induced by fever.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

The patient continued to have ischemia after PCI, and in fact had an episode of polymorphic VT shortly after while in the ICU. Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction. This was recorded 2.5 Reexamining the "gold standard" for myocardial reperfusion treatment.

STEMI 52

STEMI Myocardial Infarction Chest Pain Angioplasty 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

Across both selected patient populations, the positive predictive value was highest in patients with chest pain, with ischaemia on the electrocardiogram, and with a history of ischaemic heart disease. to 62.2%) in the UK and 4.2% (68/1631) and 16.4% (13.0% to 20.3%) in the US.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm. Evidence of acute ischemia (may be subtle) vii. Electrocardiogram-based risk stratification was useful in guiding the use of specialized cardiovascular tests. __ 9) François P.

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Arrhythmia Risk Factors Outcomes Chest Pain 52