Electrocardiogram and Stents - Cardiovascular Update

Case Report: Kounis syndrome due to cryptopteran bite

Frontiers in Cardiovascular Medicine

FEBRUARY 5, 2024

Anaphylaxis leads to plaque rupture or erosion leading to acute myocardial infarction (type II) and acute coronary stent thrombosis (type III). Outside the hospital, electrocardiogram(ECG) showed sinus rhythm, ST-segment elevation in leads V1–V3, high-sensitivity troponin 2.54 ng/ml(0–0.5 ng/ml). ng/ml(0–0.5 ng/ml).

Coronary Artery Disease

Coronary Artery Disease Electrocardiogram Myocardial Infarction Thrombosis

Is OMI an ECG Diagnosis?

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The patient was transferred to CCU to consider surgical options. Clin Cardiol 2022 4. Herman, Meyers, Smith et al.

STEMI

STEMI Chest Pain Myocardial Infarction Blog

See how bad the outcome can be if you don't know OMI findings on the ECG, and don't use the Queen of Hearts

Dr. Smith's ECG Blog

JULY 11, 2024

The attending provider wrote “Agree with electrocardiogram interpretation”. All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. The computer diagnostic algorithm diagnosed “Sinus rhythm. Normal EKG”. Normal ECG.

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Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization

Circulation

NOVEMBER 11, 2024

Electrocardiogram (ECG) showed a prominent S wave in the left-sided leads and a prominent R wave in the right-sided chest leads, suggesting dextrocardia. After guidewire crossing, balloon angioplasty was performed, and a drug-eluting stent was deployed. His vital signs were normal, and the physical examination was unremarkable.

Coronary Artery Disease

Coronary Artery Disease Angioplasty Anatomy Angina

The Importance of Regular Heart Check-Ups: What You Need to Know

AMS Cardiology

SEPTEMBER 30, 2024

These tests may include: Electrocardiogram (ECG) : Records the electrical activity of your heart. A heart check-up is a comprehensive evaluation of your cardiovascular health. It typically includes a physical examination, medical history review and diagnostic tests. Echocardiogram : Uses sound waves to create images of your heart.

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Should Emergency Physicians be interrupted by ECGs that are read as "Normal" by the computer?

Dr. Smith's ECG Blog

JUNE 12, 2017

He was found to have a 100% circumflex lesion for which a bare metal stent was placed. Laurence Katz and Jonathan Jones Safety of Computer Interpretation of Normal Triage Electrocardiograms (pages 120–124). It is not subtle any more. Interventional cardiology was consulted and patient was taken to the cath lab. References : 1.

Chest Pain

Chest Pain STEMI Myocardial Infarction Electrocardiogram

Precordial ST depression. What is the diagnosis?

Dr. Smith's ECG Blog

JANUARY 1, 2013

The OM-1 was opened and stented, then the LAD was stented 3 days later. The LAD had a 75% proximal lesion that by fractional flow reserve was hemodynamically significant. So there was 3-vessel disease, but with an acute posterior STEMI. The acute infarct-related artery was off the circumflex and the affected wall was posterior (STEMI).

STEMI

STEMI Ischemia Chest Pain Myocardial Infarction

Cardiac arrest: even after the angiogram, the diagnosis is not always clear

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was stented. Updates on the Electrocardiogram in Acute Coronary Syndromes. Electrocardiogram patterns in acute left main coronary artery occlusion. The patient was taken for an angiogram and had an 80% LAD lesion, but it could not be definitely determined whether this was an acute thrombotic lesion or a chronic stable lesion.

Cardiac Arrest

Cardiac Arrest Ischemia Defibrillator Electrocardiogram

What if your system adopted the recommendation that a computer "normal" ECG need not be shown to the doctor?

Dr. Smith's ECG Blog

JUNE 11, 2024

Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review. Below the limit of detection.

Chest Pain

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A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Dr. Smith's ECG Blog

MAY 23, 2023

LAD and D1 were stented, but flow unfortunately could not be well restored despite efforts (they list the post intervention TIMI flow still as 0). Serial tracings following stent placement confirmed the large extent of myocardial injury. LCX and RCA were described as "normal" in the cath report. Am J Emerg Med. 2022 Jan;51:384-387.

Chest Pain

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Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

Dr. Smith's ECG Blog

OCTOBER 26, 2011

An open 90% LAD was stented. A 51 year old male with h/o stent presented with 30 minutes of chest pain: Obvious anterolateral very acute STEMI with hyperacute T-waves He went for immediate PCI, with successful reperfusion of a 100% occluded proximal LAD, and a door to balloon time of 35 minutes. The LAD has reperfused early.

STEMI

STEMI Chest Pain Myocardial Infarction Angioplasty

See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. The lesion was successfully stented. As he seemed very agitated, fentanyl and diazepam were given.

STEMI

STEMI Chest Pain Myocardial Infarction Electrocardiogram

How does Acute Total Left Main Coronary occlusion present on the ECG?

Dr. Smith's ECG Blog

AUGUST 9, 2019

At the bottom of the post, I have re-printed the section on aVR in my article on the ECG in ACS from the Canadian Journal of Cardiology: New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department Case 1. Updates on the Electrocardiogram in Acute Coronary Syndromes.

Myocardial Infarction

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

A female in her 60s who was lucky to get expert ECG interpretation

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

The patient was then taken to the cath lab an found to have a proximal RCA 100% thrombotic occlusion which was successfully stented. Progression of V2 showing posterior involvement. It has generally been accepted that a QRS-T angle in the frontal plane which exceeds 45^, 50^, or 60^ is abnormal.

Chest Pain

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A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

MAY 8, 2023

So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"! 3 , 4 Q-waves defined the diagnosis of myocardial infarction before modern cardiac imaging was widely available.

Chest Pain

Chest Pain Myocardial Infarction STEMI Pacemaker

Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

It was stented. Early continuous ST segment monitoring in unstable angina: prognostic value additional to the clinical characteristics and the admission electrocardiogram. Eur Heart J 2000;21:1464–1472. Patel DJ, et al. Heart 1996;75:222–228. American Journal of Cardiology (Online First, In Press). de Wood et al.

Chest Pain

Chest Pain Thrombosis Myocardial Infarction STEMI

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

MAY 30, 2023

Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. A 12-lead electrocardiogram, lead V4R , and leads V7-9 were recorded on admission. However, raising the pulse to 60 is hardly "working" for a patient who needs a lot more cardiac output.

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

50-year old with chest pain, “no ischemic changes”

Dr. Smith's ECG Blog

DECEMBER 29, 2023

Angiogram found a totally occluded first diagonal artery, consistent with all the ECGs, which reperfused after stenting. International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction. This is usually a result of restoration of flow from collaterals.

Chest Pain

Chest Pain STEMI Myocardial Infarction Electrocardiogram

Hypertrophic Cardiomyopathy

EMS 12-Lead

MAY 20, 2022

A mid-LAD culprit lesion was identified and stented. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Cardiology felt her chest pain to be, most likely, the result of coronary supply-demand mismatch in the context of HCM endothelial remodeling (i.e.

Cardiomyopathy

Cardiomyopathy Ischemia STEMI Coronary Angiogram

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

It was treated with and dual "kissing balloons" and drug eluting stents. Here is the post stent ECG: There is greater than 50% resolution of ST elevation (all but diagnostic of successful reperfusion) and Terminal T-wave inversion (also highly suggestive of successful reperfusion). TIMI flow is 0. Door to balloon time was 51 minutes.

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

An ECG with only «marginal» change

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The culprit lesion was opened and stented. Below is the post -PCI electrocardiogram. In the cath lab the patient was found to have a 100% occlusion of a small 1st marginal branch of the LCx. Initial high sensitivity Troponin T was 810ng/L, later peaking at 2333ng/L. The ST elevation in lead aVL has disappeared.

Chest Pain

Chest Pain Blog Ischemia Risk Factors

The Bleeding Heart

EMS 12-Lead

APRIL 21, 2022

Advanced multi-vessel disease was found with stents deployed to the mid-LCx (80% stenosis), D1 (90% stensosis), and the pLAD (95% stenosis). New insights into the use of the 12 Lead Electrocardiogram for diagnosing Acute Myocardial Infarction in the emergency department. STEMI was activated and the patient went to Cath on arrival.

Ischemia

Ischemia Myocardial Infarction Blog Coronary Angiogram

This ECG was interpreted as completely NORMAL by the computer: What about it is THE critical finding??

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

They were stented. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. [link] Unbeknownst to us at the time, there was an old ECG for comparison from 3.5 years prior which I only found a day later: This is a truly normal ECG, with normal sized T-waves and normal S-waves in V2 and V3.

Chest Pain

Chest Pain STEMI Article Myocardial Infarction

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

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

You will note that it is essentially an unremarkable electrocardiogram except for some PACS. Slow TIMI 2 initially with brisk flow status post percutaneous coronary intervention with 18mm drug-eluting stent. This raised our concerns that the findings on his initial one were real. In the available view, the RCA appears fully occluded.

Chest Pain

Chest Pain Pulmonary ACE Inhibitor Pacemaker

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

distal stent patent. 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. Repeat ECG shows modest ST elevation in I and aVL and depression in inferior leads." The cath lab was activated.

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

Lesion-specific coronary artery calcium score to predict stent underexpansion

Frontiers in Cardiovascular Medicine

FEBRUARY 3, 2025

BackgroundPrevious intracoronary imaging studies have shown that coronary artery calcium (CAC) is an independent risk factor of stent underexpansion; however, limited preintervention assessments of CAC have been performed using noninvasive methods. fold increased risk of stent underexpansion in NCCT cohort and 13.56-fold

Stents

Stents Stent Electrocardiogram Ultrasound

Another MUST know ECG, and why its notoriety annoys Dr. Smith

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% At cath there was a 100% proximal LAD occlusion, which was opened and stented. of patients with anterior myocardial infarction ( 1 ). If you have seen this pattern once the diagnosis is obvious to you. Troponin T peaked at 9378 ng/L.

STEMI

STEMI Chest Pain Myocardial Infarction Ischemia

Case Report: Kounis syndrome due to cryptopteran bite

Is OMI an ECG Diagnosis?

See how bad the outcome can be if you don't know OMI findings on the ECG, and don't use the Queen of Hearts

Webinars

Abstract 4140682: Clinical Case: Flipping the Script: Tackling CAD in Dextrocardia During Cardiac Catheterization

The Importance of Regular Heart Check-Ups: What You Need to Know

Should Emergency Physicians be interrupted by ECGs that are read as "Normal" by the computer?

Precordial ST depression. What is the diagnosis?

Cardiac arrest: even after the angiogram, the diagnosis is not always clear

What if your system adopted the recommendation that a computer "normal" ECG need not be shown to the doctor?

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

See OMI vs. STEMI philosophy in action

How does Acute Total Left Main Coronary occlusion present on the ECG?

A female in her 60s who was lucky to get expert ECG interpretation

A man in his 70s with acute chest pain and paced rhythm.

Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

50-year old with chest pain, “no ischemic changes”

Hypertrophic Cardiomyopathy

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

An ECG with only «marginal» change

The Bleeding Heart

This ECG was interpreted as completely NORMAL by the computer: What about it is THE critical finding??

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

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Lesion-specific coronary artery calcium score to predict stent underexpansion

Another MUST know ECG, and why its notoriety annoys Dr. Smith

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