Dr. Smith's ECG Blog

MARCH 26, 2024

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Acute pulmonary embolism was confirmed on CT: The patient did well with treatment. Unfortunately, we don't have those details.

Chest Pain 69

Chest Pain Embolism Pulmonary Ischemia 69

Journal of the American Heart Association

OCTOBER 22, 2024

Journal of the American Heart Association, Ahead of Print.

Pulmonary 40

Pulmonary Embolism Hypertension 40

Journal of the American Heart Association

MARCH 21, 2025

Patients were stratified according to polygenic risk score tertiles and observed for the occurrence of ischemic stroke or systemic embolism, myocardial infarction, and heart failure hospitalization. P=0.011) for ischemic stroke or systemic embolism, 1.15 (95% CI, 0.821.61;P=0.422) During a median followup of 4.6

Atrial Fibrillation 40

Atrial Fibrillation Myocardial Infarction Embolism Stroke 40

DAIC

MAY 31, 2024

Clinical Cases and Poster Presentations The following list provides a brief look at the clinical cases and posters to be presented during the ACC Care of the Athletic Heart 2024 conference. All clinical cases and poster abstracts are embargoed until Thursday, June 6, 2024, at 1 p.m.

Cardiac Arrest 111

Cardiac Arrest Exercise Thrombosis Diet 111

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath. In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. When EMS found her, she was dyspneic and diaphoretic.

Cardiogenic Shock 128

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 128

ECG Cases

JUNE 6, 2023

For RV strain, acute vs chronic, we should look for signs of acute RV strain and chronic pulmonary hypertension. for low voltages we should consider pericardial effusion and other causes, and for hyperkalemia we should look for multiple signs of hyperkalemia as a guide for empiric calcium.

STEMI 106

STEMI Pulmonary Blog Ischemia 106

Frontiers in Cardiovascular Medicine

FEBRUARY 14, 2024

Specifically, this genetic factor was found to lower the risk of type 2 diabetes by 46.5%, coronary heart disease by 37.5%, ischemic stroke by 35.4%, cardiac-related mortality by 28.6%, heart failure by 28.2%, transient ischemic attack by 24%, atrial fibrillation by 15.2%, peripheral artery disease by 0.3%, and hypertension by 0.3%.

Education 49

Education Cardiovascular Disease Peripheral Arterial Disease Genetic predisposition 49

Frontiers in Cardiovascular Medicine

JANUARY 18, 2024

A relationship between hypertension, a history of severe preoperative embolism, and warfarin dose is found, which provides a useful reference for the warfarin dose administration in the future. mg/day, 0.13 mg/day), root mean square errors (0.18 mg/day, 0.20 mg/day) and R 2 (0.87, 0.82).

Embolism 64

Embolism Hypertension 64

MIBHS

OCTOBER 31, 2024

High Blood Pressure (Hypertension) Persistent high blood pressure forces the heart to work harder to pump blood. 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 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

HeartRhythm

JUNE 30, 2024

While new-onset LBBB might be indicative of acute coronary syndrome, RBBB may be associated with lung pathologies, pulmonary embolism, and pulmonary hypertension. Although RBBB is generally considered a relatively benign finding, recent data suggest an increased cardiovascular risk when detected in a general population [1].

Embolism 40

Embolism Pulmonary Hypertension 40

Dr. S. Venkatesan MD

JANUARY 30, 2025

Topic: Chronic thrombo embolic pulmonary hypertension.(CTEPH) This is a GIF run through of a recent presentation in PH seminar at Coimbatore, India. CTEPH) In this lecture, I have tried to highlight 1.Newer Newer definitions, Incidence and prevalence of CTEPH 2.The The pathologic transition phase between acute PE to CTEPH 3.Risk

Pulmonary 40

Pulmonary Embolism Risk Factors Hypertension 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

IntroductionCerebral venous sinus thrombosis (CVST) presents diagnostic challenges, especially in its overlap with idiopathic intracranial hypertension (IIH). A cerebral angiogram showed a left occipital AV fistula, treated with onyx embolization. Stroke: Vascular and Interventional Neurology, Volume 3, Issue S2 , November 1, 2023.

Embolism 40

Embolism Thrombosis Hypertension Diabetes 40

Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia.

Tachycardia 129

Tachycardia Atrial Fibrillation AFIB Atrial Flutter 129

All About Cardiovascular System and Disorders

MAY 22, 2024

About a fifth of all ischemic strokes are attributed to embolization of ruptured atherosclerotic plaque from carotid arterial stenosis. It has been mentioned that risk due to clonal hematopoiesis is equal in magnitude to conventional risk factors like smoking, hypertension, dyslipidemia and diabetes.

Stenosis 52

Stenosis Stroke Strokes Risk Factors 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. CT chest showed left sided pulmonary embolism and a pulmonary infarct that had previously been mistaken for pneumonia. Past medical history included diabetes and hypertension. Vitals were normal.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

APRIL 27, 2012

He had a history of pulmonary embolism but was no longer on coumadin and states the pain is different. The patient was very hypertensive and had back pain, so they did a CT of his chest to rule out dissection. 56 y/o male who presented with 12/10 severe chest pain starting at 3AM, radiating to his upper back. Wraparound?

Chest Pain 52

Chest Pain Embolism Ischemia Pulmonary 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Often caused by sudden interruption of blood flow to the spinal cord due to embolic phenomena, intrinsic factors such as connective tissue disease, and due to intra/post‐operative hypotension leading to ischemia or infarction. IntroductionSpinal cord infarctions (SCI) are scarce entities, constituting only 0.3‐1%

Embolism 40

Embolism Thrombolysis Cancer Ischemia 40

Stroke Journal

DECEMBER 8, 2023

BACKGROUND:Aortic arch plaques are associated with an increased risk of ischemic stroke in patients with cryptogenic stroke or prior embolic events. CONCLUSIONS:Aortic arch plaques may be a marker of cardiovascular risk rather than a direct embolic stroke source in older adults without prior stroke. Stroke, Ahead of Print.

Plaque 40

Plaque Aortic Stroke Strokes 40

Stroke Journal

JANUARY 30, 2025

Background:The STRACK project aims to improve post-stroke patient management and the transition from acute to primary care thanks to improvements in patient pathways and monitoring cardiovascular risk factors: heart failure, diabetes, atrial fibrillation, dyslipidemia and hypertension.

Stroke 40

Stroke Strokes Atrial Fibrillation Risk Factors 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism. He had multiple cardiac arrests with ROSC regained each time. This is a quiz.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Stroke Journal

JANUARY 30, 2025

We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS).Results:The Patients with atrial cardiopathy, compared to those without, were older (median age, 77 years versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation.

Cancer 40

Cancer Stroke Strokes Atrial Fibrillation 40

Dr. Smith's ECG Blog

AUGUST 14, 2023

The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) When you suspect pulmonary embolism due to large RV on POCUS, always look for right axis deviation and a large R-wave in V1 because the large RV may be entirely due to chronic RVH, not acute PE. Here is his triage ECG: What do you think?

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Stroke Journal

FEBRUARY 1, 2024

Patients with a high risk of metabolic syndrome (>= 2 of the following: hypertension, diabetes, hyperlipidemia, or obesity) have a higher risk of AIS (1.37, 1.13 - 1.65), AMI (1.81, 1.19 - 2.75), and MACE (1.28, 1.13 - 1.44).Conclusions:Developing Results:Among 10,652 ICH patients (median age [IQR]: 70 [58 - 80] years; 47.7%

Hemorrhage 40

Hemorrhage Myocardial Infarction Atrial Fibrillation Medicare 40

Dr. Smith's ECG Blog

MARCH 12, 2018

Notice I did not say "pulmonary embolism," because any form of severe acute right heart strain may produce this ECG. This includes, but is not limited to, PE, asthma/COPD exacerbation, hypoxic vasoconstriction from pneumonia, acute pulmonary hypertension exacerbation. Differences of Pulmonary Embolism T-waves from Wellens' T-waves: 1.

Chest Pain 40

Chest Pain Pulmonary Embolism Tachycardia 40

The British Journal of Cardiology

NOVEMBER 29, 2023

Strokes can be thrombotic, embolic or haemorrhagic. Stroke is a major cause of mortality, morbidity and economic burden. The key risk factor for cardioembolic stroke is atrial fibrillation or flutter, and oral anticoagulation (OAC) is recommended in all but the lowest-risk patients with evidence of these arrhythmias.

Stroke 40

Stroke Strokes Risk Factors Blood Pressure 40

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Postoperatively, the patient was hypertensive to a systolic blood pressure of 220 mmHg that was controlled with a nicardipine infusion that was gradually weaned off once the patient’s vitals were stable while in the Neuro‐ICU. There was no opacification of the aneurysms at the end of the procedure and no procedural complications (Figure 1D).

Aneurysm 40

Aneurysm Peripheral Arterial Disease Coronary Artery Disease ICU 40

Stroke Journal

JANUARY 30, 2025

Adverse vascular outcomes used as endpoints include acute ischemic stroke, acute myocardial infarction, deep vein thrombosis/pulmonary embolism, AF, and carotid artery dissection.A Patients with any adverse vascular outcomes before the index ECG were excluded. total of 31301 patients (13783 MwA, 17518 MwoA) were included in our analysis.

Atrial Fibrillation 40

Atrial Fibrillation Outcomes Coronary Artery Disease Myocardial Infarction 40

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. A new right bundle branch block in a sick patient with chest pain and/or shortness of breath is a worrisome finding concerning for LAD occlusion or significant pulmonary embolism.

Chest Pain 52

Chest Pain Pericarditis Embolism Stent 52

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. Chest Pain – Benign Early Repol or OMI? The culprit mid LAD lesion was stented.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart attacks 120

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) Effect of Gamification, Financial Incentives or Both Combined to Increase Physical Activity Among Patients with Elevated Risk For Major Adverse Cardiovascular Events.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. Smith's ECG Blog

APRIL 26, 2017

Low LV filling pressures are due to several etiologies, most commonly due to volume depletion (dehydration or hemorrhage), but also due to other etiologies including, but not limited to: mitral stenosis, pulmonary hypertension (chronic, or due to pulmonary embolism), or poor RV performance.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

My answer: "This is classic for PE, but it can also be present in any hypoxia due pulmonary hypoxic vasoconstriction and resulting acute pulmonary hypertension and acute right heart strain. An ECG was texted to me (Smith) without any clinical information: What did I say? This is NOT Wellens. Is the patient hypoxic? The answer was yes.

Chest Pain 52

Chest Pain Pulmonary Tachycardia Embolism 52

Dr. Smith's ECG Blog

APRIL 9, 2023

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell Meyers A man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. This is written by Willy Frick, an amazing cardiology fellow in St. He described it as "10/10" intensity, radiating across his chest from right to left.

Plaque 127

Plaque Angina Blog Stent 127

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The patient had no hypertension, no tachycardia, a normal hemoglobin, no drug use, no hypotension/shock, no murmur of aortic stenosis. The patient had been on a long drive, suggesting possible pulmonary embolism (this was unlikely given absence of tachyardia, hypoxia, or any other feature of PE), so we sent a d dimer.

Chest Pain 52

Chest Pain STEMI Aortic Pulmonary 52

All About Cardiovascular System and Disorders

APRIL 30, 2024

in hypertensives are some of the features. Mid cavity obstruction in HCM is associated with apical aneurysm, systemic embolism, and arrhythmias. Hypertensive heart disease is an important differential diagnosis, but SAM is rare in this situation and there is evidence of greater diastolic dysfunction in HCM.

Cardiomyopathy 40

Cardiomyopathy Bicuspid/Mitral Document Arrhythmia 40

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. You may see a filling defect in distal LAD, most probably due to an embolization from proximal lesion. Written by Emre Aslanger.

Chest Pain 52

Chest Pain Myocardial Infarction Blog Pericarditis 52