Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. And yet the arteries remain open.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

JUNE 11, 2021

Similarly, STEMI guidelines call for urgent angiography for refractory ischemia or electrical/hemodynamic instability, regardless of ECG findings. So there is now high pre-test probability + refractory ischemia + Modified Sgarbossa + dynamic ECG changes. The patient still had chest pain and a third ECG was performed. Learning points 1.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

APRIL 26, 2017

My opinion was that it was not a cath lab case, but I did suggest they do a bedside ultrasound to look for an anterior wall motion abnormality. I had not seen the cardiac ultrasounds at this time. The patient was given aspirin and heparin and admitted to the hospital. I did not have more information at the time.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Down-up T-waves in inferior leads are almost always reciprocal to ischemia in the territory underlying aVL. This is not normal and is a tip off that there is posterior ischemia accompanying the ischemia in aVL. Data from stress testing proves that the ST depression of ischemia does not localize.

Ischemia 40

Ischemia Chest Pain STEMI Stenosis 40

Dr. Smith's ECG Blog

OCTOBER 2, 2021

He had been seen several weeks ago at an outside hospital for a similar issue and had been discharged home, presumably after unremarkable workup. This proves that the first one was, surprisingly, due to ischemia!! He was ultimately discharged after a brief, uncomplicated hospital course. Peak troponin level unknown.

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. These findings are diagnostic of an apical OMI as a result of LAD Occlusion.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. She was discharged after a short hospitalization with oncology and cardiology follow-up. This patient is only pseudo-stable.

Tachycardia 40

Tachycardia Pericarditis Ultrasound Blood Pressure 40

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Dr. Nossen performed a bedside ultrasound which was interpreted as normal. Learning Points: Ectopic atrial rhythm can produce atrial repolarization findings that can be confused for acute ischemia, STEMI, or OMI. The 1st Clue in today's case that cardiac catheterization was probably not needed — is in the History.

Blog 52

Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. If there is polymorphic VT with a long QT on the baseline ECG, then generally we call that Torsades, but Non-Torsades Polymorphic VT can result from ischemia alone. He was managed medically with Clopidogrel. mg/dL [1.03 0.16

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. 3 studied 416 patients hospitalized with COVID in China, of whom 82 had an initial cTn(I) above the upper reference limit. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. 3–8 Shi et al. Available from: [link] 3.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). The patient was started on dual antiplatelet therapy and discharged from the hospital on day 3 without further event. J Am Heart Assoc. 2021 Dec 7;10(23):e022866. 121.022866.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

RCA ischemia often results in sinus bradycardia from vagal reflex or ischemia of the sinus node. They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). The patient never arrested during his time at the hospital and his prognosis is good.

Bradycardia 40

Bradycardia Cardiogenic Shock STEMI Ischemia 40

Dr. Smith's ECG Blog

JANUARY 9, 2023

He was then transferred to quaternary care childrens hospital. Beware a negative Bedside ultrasound. No apical thrombus noted using Definity contrast. Coxsackie serologies negative. Covid PCR negative. UDS positive for marijuana only. There, troponins were trended up to 100,000 ng/L (still unknown if troponin I or T). Pericarditis?

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Case 4 Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 To me, this makes the ECG nearly diagnostic of ischemia, though if it is LAD occlusion, there should be ST depression in III and aVL, so it is a bit confusing. 100% LAD occlusion. consistent with LAD occlusion) It was not diagnosed.

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Circulation

NOVEMBER 11, 2024

We computed a Vascular Disease (VasD) score, integrating the presence of carotid plaque (CP) on carotid ultrasound, known coronary artery disease (CAD), and myocardial ischemia (MyI). Subsequently, patients were followed for 5.5 Survival curves depicted a rising risk of the outcome corresponding to increasing VasD scores (Figure 1).Conclusions:The

Exercise 40

Exercise Coronary Artery Disease Ultrasound Plaque 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Evidence of acute ischemia (may be subtle) vii. Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Dr. Smith's ECG Blog

MARCH 6, 2020

There is no evidence of infarction or ischemia. A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function. The patient was given furosemide and admitted to the hospital. There are nonspecific ST-T abnormalities. Troponin I was 0.054 ng/mL NT-ProBNP was 8316 (0-900 pg/mL). "

Heart Failure 52

Heart Failure Tachycardia Atrial Flutter Cardiomyopathy 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2024

These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. He took two full strength aspirin prior to EMS arrival. The pain was relieved by one prehospital NTG spray.

STEMI 110

STEMI Ultrasound Blog Chest Pain 110

Dr. Smith's ECG Blog

MARCH 3, 2025

I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Cardiology services were consulted at a PCI capable hospital. The patient was started on heparin for possible NSTEMI vs demand ischemia. Smith : these ECGs do NOT show subendocardial ischemia.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. Smith's ECG Blog

DECEMBER 3, 2024

Case continued A bedside cardiac ultrasound revealed grossly preserved left ventricular function, no appreciable wall motion abnormality, pericardial effusion, or obvious valvular abnormality. A good size infarct that no longer has active ischemia will have continually rising troponins due to the damage that was done hours ago.

Catheterization Laboratory 111

Catheterization Laboratory STEMI Blog Ischemia 111