The roles of neutrophils in cardiovascular diseases
Frontiers in Cardiovascular Medicine
MARCH 18, 2025
Finally, we also emphasize the preclinical/clinical translational significance of neutrophil-targeted strategies.
Two promising approaches in the treatment of myocardial infarction: stem cells and gene therapy
Frontiers in Cardiovascular Medicine
FEBRUARY 19, 2025
CVDs include coronary heart disease, stroke, hypertension, and peripheral vascular diseases. These methods only alleviate symptoms of heart failure and myocardial ischemia and improve patients' quality of life by partially restoring myocardial reperfusion. In China, the death rate of CVDs ranks the first in all major diseases.
An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?
Dr. Smith's ECG Blog
MAY 20, 2024
A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.
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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.
Dr. Smith's ECG Blog
APRIL 14, 2024
A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. No ischemia. An inferior wall motion abnormality does NOT say that there is active ischemia because previous ischemia will result in persistent wall motion abnormality (stunning).
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ECG Cases 43 – ECG Interpretation in Shortness of Breath
ECG Cases
JUNE 6, 2023
We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR.
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Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.
Dr. Smith's ECG Blog
NOVEMBER 26, 2018
He was hypertensive and tachycardic, with mildly increased work of breathing. In some cases the ischemia can be seen "through" the flutter waves, whereas in other cases the arrhythmia must be terminated before the ischemia can be clearly distinguished. Here is his initial ECG: What do you think? How many problems does he have?
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ECG Blog #412 — Is Cardiac Cath Indicated?
Ken Grauer, MD
JANUARY 13, 2024
The ECG in Figure-1 was obtained from a middle-aged man with known hypertension — who presented to the ED ( E mergency D epartment ) for CP ( C hest P ain ) over the preceding 2-3 days. My written interpretation on a tracing such as this one would read, "Marked LVH and 'strain' and/or ischemia — with need for clinical correlation."
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Abstract 087: Cocaine?Induced Acute Spinal Cord Ischemia Syndrome
Stroke: Vascular and Interventional Neurology
NOVEMBER 9, 2023
IntroductionAcute spinal cord ischemia syndrome (ASCIS) is a rare disease that is thought to comprise roughly only 1.2% The mechanism is thought to be multifactorial due vasospasm, cerebral vasculitis, vascular thrombosis, cardioembolism from cocaine‐induced myocardial infarction or cardiomyopathy, and hypertensive surges [9].
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Abstract WP303: Hypertension Disrupts the Relationship Between Pial Collateral Flow and Tissue Oxygenation During Ischemic Stroke
Stroke Journal
FEBRUARY 1, 2024
Introduction:Chronic hypertension decreases collateral blood flow through leptomeningeal anastomoses (LMAs) during ischemic stroke, which has been linked to worsened stroke outcome. Methods:Transient middle cerebral artery occlusion was used to induce ischemia for 2 hours. mmHg at 60 min. However, oxygenation did not recover in SHR (5.9±0.23
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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR.
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Avocados for the Heart; Cardiology's Sad State; CBD for Pulmonary Hypertension?
Heart 2023 Conference
APRIL 20, 2022
Source: JAMA Cardiology) Patients with afib who survived an intracerebral haemorrhage had a very significant risk of cerebrovascular ischemia episodes and death in the following year, according to registry data. JACC: Asia) Lexaria Bioscience has announced that a CBD product beats a placebo in simulating acute pulmonary hypertension.
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AT1?AA Is Produced in Offspring in Response to Placental Ischemia and Is Lowered by B?Cell Depletion Without Compromising Overall Offspring Health
Journal of the American Heart Association
FEBRUARY 14, 2024
BackgroundPreeclampsia, new‐onset hypertension during pregnancy alongside other organ dysfunction, is the leading cause of mortality for the mother and low birth weight for the baby. Journal of the American Heart Association, Ahead of Print. Low birth weight contributes to high risk of cardiovascular disorders later in life.
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ECG Blog #424 — Proportionality and the "Cut Off"
Ken Grauer, MD
APRIL 5, 2024
The ECG in Figure-1 was obtained from a middle-aged woman — who presented with low back pain, shortness of breath and marked hypertension — but no CP ( C hest P ain ). As a result, the ST elevation ( with especially tall, peaked T wave in lead V2) — is not indication of acute ischemia. Figure-1: The initial ECG in today's case.
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A man in his 30s with chest pain. How was he managed? What if they had used the Queen of Hearts?
Dr. Smith's ECG Blog
JANUARY 20, 2024
Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. Vitals were within normal limits except some hypertension. Which is true.
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Do you need to be a trained health care professional to diagnose subtle OMI on the ECG?
Dr. Smith's ECG Blog
MAY 5, 2024
He interprets here: "This EKG is diagnostic of right bundle branch block and transmural ischemia of the anterior wall, most likely from an occlusion of the proximal LAD. It was recorded at 0530: What do you think? The young ED tech immediately suspected LAD OMI. There is a hyperacute distribution of T waves from V1 to V4.
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Normal angiogram one week prior. Must be myocarditis then?
Dr. Smith's ECG Blog
JUNE 5, 2024
He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder. The ECG does not show any definite signs of ischemia. Written by Magnus Nossen The patient in todays case is a 50 year old male. He denied any exertional chest pain. The below ECG was recorded. The below ECG was recorded.
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Abstract WP402: Hypertension-linked oxidative stress and inflammatory transcriptomic pathways in the brain cortical regions of a rat model following ischemic stroke
Stroke Journal
JANUARY 30, 2025
Background:Patients with hypertension (HTN) are almost 3 times more likely to have a stroke than non-hypertensive individuals. In experimental models, normotensive Sprague-Dawley (SD) and Spontaneously Hypertensive Rats (SHR) show different susceptibilities and outcomes to ischemic stroke. fold), IL-6 (3.3-fold), fold), FAS (1.7-fold),
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See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.
Dr. Smith's ECG Blog
OCTOBER 20, 2024
Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. The first task when assessing a wide complex QRS for ischemia is to identify the end of the QRS. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness.
Understanding an Enlarged Heart (Cardiomegaly): Causes, Symptoms, and Treatment
MIBHS
OCTOBER 31, 2024
High Blood Pressure (Hypertension) Persistent high blood pressure forces the heart to work harder to pump blood. This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Here are some of the most common causes: 1.
Ischemic ST depression maximal in V1-V4 (vs. V5-V6), even if less than 0.1 millivolt, is specific for Occlusion Myocardial Infarction (vs. subendocardial non-occlusive ischemia)
Dr. Smith's ECG Blog
JUNE 27, 2021
A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chest pain, sharp, radiating down left arm, cramping, that waxes and wanes but never goes completely away. If this STD were due to LVH or to subendocardial ischemia, rather than posterior OMI, it would be maximal in V5 and V6.
Vascular Inflammation and Smooth Muscle Contractility: The Role of Nox1-Derived Superoxide and LRRC8 Anion Channels
Hypertension Journal
JANUARY 4, 2024
Hypertension, Ahead of Print. Vascular inflammation underlies the development of hypertension, and the mechanisms by which it increases blood pressure remain the topic of intense investigation. These pathways share a dependence upon redox signaling, and excessive activation promotes oxidative stress that promotes vascular aging.
Non-ischemic phenotypes of low-risk chest pain patients based on exercise stress echocardiography: a pilot study
Frontiers in Cardiovascular Medicine
FEBRUARY 18, 2025
ObjectiveA significant proportion (85%) of low-risk non-ST-elevation acute coronary syndrome (NSTE-ACS) patients do not receive objective confirmation of ischemia by stress echocardiography (SE), yet remain a healthcare burden due to lower long-term survival and overuse of medical services.
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See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens
Dr. Smith's ECG Blog
NOVEMBER 3, 2023
A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. The baseline ECG is basically normal with no ischemia. In my opinion, I think it looks more like subendocardial ischemia.
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Instructors' Collection ECG: Severe Triple Vessel Disease
ECG Guru
JULY 30, 2023
The patient is a heavy smoker, diabetic and hypertensive with a long history of non-compliance to his medications. This is an ECG sign of GLOBAL ISCHEMIA. The Patient: This ECG is from a 63-year-old man who complained of epigastric pain for three hours. There are several possible causes, all bad.
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A man in his 50s with shortness of breath
Dr. Smith's ECG Blog
MARCH 26, 2024
There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Aslanger's is a combination of acute inferior OMI plus subendocardial ischemia, and due to the ischemia vectors , it has STE only in lead III. Moreover, there is tachycardia.
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The Bleeding Heart
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] The patient was found to be hypertensive and treated accordingly.
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Cardiac arrest: even after the angiogram, the diagnosis is not always clear
Dr. Smith's ECG Blog
OCTOBER 28, 2013
A woman in her 40's who was healthy, except for hypertension, was at work when she suddenly complained of neck and shoulder pain and then collapsed. STE limited to aVR is due to diffuse subendocardial ischemia, but what of STE in both aVR and V1? Was this: 1) ACS with ischemia and spontaneous reperfusion? see below).
ECG Blog #383 — Is this Coronary Disease?
Ken Grauer, MD
JUNE 6, 2023
Part of the ST depression with deep T wave inversion in the lateral chest leads clearly reflects LV "strain" from the marked LVH — but despite the very large QRS amplitudes, this ST-T wave appearance looks disproportionate, suggesting at least a component of ischemia. Then there is the significant ST elevation we see in lead V1.
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Long‐Term Outcomes of Peripheral Artery Disease in Veterans: Analysis of the Peripheral Artery Disease Long‐Term Survival Study (PEARLS)
Journal of the American Heart Association
MARCH 21, 2025
Study end points include mortality, cardiovascular events (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using Veterans Affairs and nonVeterans Affairs encounters.ResultsThe mean age was 70.6 were male, and 18.5% At 1 year, 9.4%
A Non STEMI that needs the cath lab now.
Dr. Smith's ECG Blog
APRIL 2, 2014
He had some cardiac risk factors including hypertension, on meds, but no previous coronary disease. There is about 1 mm of STE in aVR I con sidered but rejected subendocardial ischemia. Is it subendocardial ischemia, or inferior MI? A male in his 60's called 911 for chest pain. Here is his prehospital ECG: Diagnosis?
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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?
Dr. Smith's ECG Blog
NOVEMBER 4, 2022
Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. His response: “subendocardial ischemia.
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A 50-something with chest pain. Is there OMI? And what is the rhythm?
Dr. Smith's ECG Blog
MARCH 22, 2024
Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible.
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Critical Left Main
EMS 12-Lead
JULY 24, 2023
It should be known that each category can easily manifest the generic subendocardial ischemia pattern. In general, subendocardial ischemia is a consequence of global supply-demand mismatch that usually ameliorates upon addressing, and mitigating, the underlying cause. What’s interesting is that the ECG can only detect ischemia.
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Important Complications of Eisenmenger Syndrome
All About Cardiovascular System and Disorders
MARCH 26, 2024
Transcript of the video: Eisenmenger syndrome is an important complication of large left to right shunts which develop later due to development of pulmonary vascular obstructive disease and severe pulmonary hypertension. Some even say that those with Eisenmenger in ASD are really those who are destined for primary pulmonary hypertension.
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Physical Examination as a Helpful Aid in Decision-Making in Challenging ECGs
Dr. Smith's ECG Blog
JANUARY 1, 2024
His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. The patient rapidly regained consciousness, reporting no residual pain.
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RBBB with dynamic T-waves
Dr. Smith's ECG Blog
APRIL 27, 2012
Here are V1-V3 from the last 3 ECGs: It is now clear that there is cardiac ischemia. The patient was very hypertensive and had back pain, so they did a CT of his chest to rule out dissection. Not much change from 15 minute prior, but abnormalities are persistent. Wraparound? It was negative.
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Chest Pain Diagnosed as Gastroesophageal Reflux
Dr. Smith's ECG Blog
MAY 29, 2017
He had some "pre-diabetes ," but no h/o hypertension, no known family history of heart disease, and he smokes about 1-2 cigarettes per day. Ischemia 3. The ST depression in precordial leads suggest still more widespread ischemia, so the exact culprit is not at all clear. He had been pain free for about an hour. Normal Variant 2.
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52 Orthostatic Blood Pressure Change, Dizziness, and Risk of Dementia in the ARIC Study: Dementia Series
Hypertension Journal
OCTOBER 23, 2023
Hypertension, Ahead of Print. BACKGROUND:Abnormal orthostatic blood pressure (BP) regulation may result in cerebral hypoperfusion and brain ischemia and contribute to dementia. It may also manifest as early symptoms of the neurodegenerative process associated with dementia.
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40 Abstract WP313: Towards Molecular Profiling of Transient Ischemic Attack Mimics for Triage
Stroke Journal
FEBRUARY 1, 2024
Differential expression (DE) analyses (fold change >
A 31 year old with Diabetes and HTN complains of bilateral arm tingling and headache
Dr. Smith's ECG Blog
AUGUST 30, 2020
Never chest pain but had to treat as hypertensive emergency. In fact, severe hypertension by itself can lead to greatly increased oxygen demand and type 2 acute MI, sometimes with ST Elevation. In fact, severe hypertension by itself can lead to greatly increased oxygen demand and type 2 acute MI, sometimes with ST Elevation.
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Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome
Dr. Smith's ECG Blog
NOVEMBER 15, 2013
This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Also see this incredible case of the use of 12-lead ST Segment monitoring.
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Dynamic, Reversible, Ischemic T-wave inversion mimics Wellens'. All trops negative.
Dr. Smith's ECG Blog
DECEMBER 14, 2018
He had a history of hypertension but stopped taking his medication several years ago. This was my interpretation: although most ischemic T-wave inversion is post -ischemic like Wellens, sometime active ischemia results in isolated T-wave inversion. The pain resolved as he arrived to the emergency department. BP was 200/100.
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Judge for yourself the management of this patient with "NSTEMI, multivessel disease"
Dr. Smith's ECG Blog
SEPTEMBER 10, 2023
Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. Smith : the profound persistent STE suggests either persistent occlusion or " no reflow " with persistent downstream ischemia.
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LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life
Dr. Smith's ECG Blog
JUNE 11, 2021
Case submitted and written by Dr. Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. So there is now high pre-test probability + refractory ischemia + Modified Sgarbossa + dynamic ECG changes.
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