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.

Chest Pain 120

Chest Pain STEMI Myocardial Infarction Electrocardiogram 120

All About Cardiovascular System and Disorders

NOVEMBER 16, 2023

Mechanism is thought to be due to sustained sympathetic stimulation, probably caused by dysfunction of insular cortex resulting in reversible neurogenic damage to the myocardium which could include contraction bands and subendocardial ischemia [2]. Lead electrocardiogram changes after supratentorial intracerebral hemorrhage.

Hemorrhage 52

Hemorrhage Myocardial Infarction Aneurysm Electrocardiogram 52

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. Electrocardiogram (ECG/EKG) An ECG records the electrical activity of the heart and can help detect abnormalities in the heart’s rhythm that might contribute to enlargement.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

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

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.

Chest Pain 117

Chest Pain Bradycardia Blog Electrocardiogram 117

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

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.

Tachycardia 113

Tachycardia Blog Ischemia Heart Failure 113

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 121

STEMI Chest Pain Myocardial Infarction Blog 121

All About Cardiovascular System and Disorders

MARCH 25, 2024

Pediatric exercise testing may be used for evaluation of various disorders of cardiac rhythm rather than for inducible ischemia as in adults. Discussion on pediatric exercise testing. In a child with suspected sinus node dysfunction, chronotropic incompetence from sinus node dysfunction can be assessed by exercise testing.

Exercise 52

Exercise Pediatrics Congenital Tachycardia 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.

Cardiac Arrest 52

Cardiac Arrest Heart Attack Heart attacks Atrial Fibrillation 52

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." When the ischemia is resolved, the wall motion may completely recover, or there may be persistent stunning.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 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

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.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

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.

Stenosis 52

Stenosis Coronary Artery Bypass Graft Coronary Artery Disease Document 52

Dr. Smith's ECG Blog

MARCH 8, 2021

This was just published in JAMA Internal Medicine: The de Winter Electrocardiogram Pattern Evolving From Hyperacute T Waves It reminded me that many believe, due to the assertions in the original de Winter's article, that de Winter's waves are stable.

Chest Pain 52

Chest Pain STEMI Ischemia Critical Care 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

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 Ischemia Myocardial Infarction 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.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 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.

Chest Pain 61

Chest Pain Blog Ischemia Risk Factors 61

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 40

Chest Pain Ischemia Angina Electrocardiogram 40

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 Chest Pain Myocardial Infarction Angioplasty 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.

Chest Pain 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Background: The value of the 12-lead ECG in the diagnosis of non-ST-elevation myocardial infarction (NSTEMI) is limited due to insufficient sensitivity and specificity of standard markers of ischemia and because ECG confounders may prevent their application.

Chest Pain 52

Chest Pain Critical Care Article Pacemaker 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 STEMI Angina 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 Chest Pain Circulation Electrocardiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

These findings are concerning for inferior wall ischemia with possible posterior wall involvement. You will note that it is essentially an unremarkable electrocardiogram except for some PACS. The morphology in V2 is also concerning and it appears that the ST segment is being pushed down, as in ST depression.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

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

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.

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

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

Journal of Cardiovascular Electrophysiology

FEBRUARY 13, 2024

Long-term Follow-up of Patients with Brugada Syndrome from a Tertiary Referral Center in Iran Abstract Background Brugada syndrome (BrS) is characterized by ST-segment elevation in the right precordial leads, which is not explained by ischemia, electrolyte disturbances, or obvious structural heart disease. 01), longer PR interval ( p =.03),

Electrocardiogram 40

Electrocardiogram Defibrillator Ischemia Heart Disease 40

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.

Quality of Life 52

Quality of Life Myocardial Infarction Public Health Arrhythmia 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.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Frontiers in Cardiovascular Medicine

FEBRUARY 5, 2025

Exercise electrocardiograms were recorded at the National Center of Internal Medicine and Cardiology, Bishkek (760m) and on the day of arrival at the Tuja Ashu high-altitude clinic (3,100m), Kyrgyzstan. The mean difference (95% CI) in STE between post-peak exercise between 3,100m and 760m was 0.22mm (0.06 to 0.39) and 0.09mm (0.06

Exercise 52

Exercise Ischemia Electrocardiogram Pulmonary 52

Frontiers in Cardiovascular Medicine

JANUARY 8, 2025

BackgroundPainful left bundle branch block (LBBB) syndrome is an uncommon disease that is defined as intermittent episodes of angina associated with simultaneous LBBB changes on an electrocardiogram (ECG) with the absence of flow-limiting coronary artery disease or ischemia on functional testing.

Chest Pain 52

Chest Pain Angina Coronary Artery Disease Blood Pressure 52

Dr. Smith's ECG Blog

FEBRUARY 12, 2025

Artificial intelligence (AI) algorithms show promise to improve electrocardiogram (ECG) interpretation. Methods Electrocardiograms were categorized by (1) STEMI criteria, (2) ECG integrated device software and (3) a proprietary AI algorithm (Queen of Hearts (QOH), Powerful Medical).

Chest Pain 82

Chest Pain STEMI Electrocardiogram Blog 82

Dr. Smith's ECG Blog

JANUARY 31, 2025

The de Winter electrocardiogram pattern is an infrequent presentation, reported to occur in 2% to 3.4% In this situation, even after the ischemia is relieved and myocardial blood flow is restored myocardial contractile function remains impaired for a variable period of time (usually days to a few weeks). References: Kloner, R.

STEMI 114

STEMI Chest Pain Myocardial Infarction Ischemia 114