Dr. Smith's ECG Blog

APRIL 14, 2024

No ischemia. This is a conundrum, because it is clear that the patient is having an acute MI, the ECG is dynamic, but the pain is very mild and there is no ECG evidence of active transmural ischemia. We already know that the ischemia is ongoing, though mild (because of the persistent pain). Q-waves are even more pronounced.

Chest Pain 119

Chest Pain Ischemia Myocardial Infarction Ultrasound 119

Journal of the American Heart Association

APRIL 7, 2025

BackgroundStrain assessed by cardiac magnetic resonance (CMR) is a key prognostic indicator in myocardial infarction. However, the strain characteristics and prognostic value in myocardial infarction with nonobstructive coronary arteries (MINOCA) with different causes are unclear.

Myocardial Infarction 40

Myocardial Infarction Atrial Fibrillation Angina Ischemia 40

Journal of Cardiovascular Pharmacology

OCTOBER 24, 2024

In the heart, autophagy is regulated mainly through mitophagy due to the metabolic changes of cardiomyocytes caused by ischemia and hypoxia. Myocardial remodeling is characterized by gradual heart enlargement, cardiac dysfunction, and extraordinary molecular changes.

Myocardial Infarction 40

Myocardial Infarction Ischemia Heart Failure Heart Disease 40

Dr. Smith's ECG Blog

MAY 27, 2024

The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. Hence the first ECG was labeled 'anterior ischemia' based on ST depression, rather than identifying this as reciprocal from posterior OMI. But are there any other signs of Occlusion MI? Meyers et al.

Chest Pain 123

Chest Pain STEMI Myocardial Infarction Ischemia 123

Dr. Smith's ECG Blog

OCTOBER 24, 2013

Such T-waves are almost always reciprocal to ischemia in the region of aVL (although aVL looks n ormal here) , and in a patient with chest pain are nearly diagnostic of ischemia. Ischemia on the ECG can be very subtle and is easily missed. Did the ECG offer unseen hints? Lesson : 1.

Cardiac Arrest 52

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia 52

American College of Cardiology

OCTOBER 29, 2024

Both acute and long-term colchicine use to treat patients with acute myocardial infarction (MI) did not reduce cardiovascular death, myocardial infarction, stroke or ischemia-driven revascularization.

Myocardial Infarction 58

Myocardial Infarction Research Ischemia Strokes 58

DAIC

MAY 8, 2024

6 This novel study marks a significant milestone in the field, evaluating the effectiveness of FFR CT in detecting ischemia-producing coronary stenosis in patients with severe PAD. Diagnosis and treatment of ischemia-producing coronary stenoses improves 5-year survival of patients undergoing major vascular surgery.” 101272, [link].

Coronary Artery Disease 111

Coronary Artery Disease Chest Pain Ischemia Myocardial Infarction 111

Frontiers in Cardiovascular Medicine

JUNE 18, 2024

BackgroundSlow flow/no-reflow (SF-NR) during percutaneous coronary intervention (PCI) is associated with poor prognosis of patients with acute myocardial infarction (AMI). Currently, effective treatment is not available for SF-NR. However, its effects on SF-NR in the AMI patients during PCI are not clear.

Myocardial Infarction 52

Myocardial Infarction Biomarkers Laboratory Ischemia 52

Dr. Smith's ECG Blog

AUGUST 26, 2024

There is akinesis of the distal septum, anterior, apex, and distal inferior wall consistent with LAD territory ischemia or infarction. How large is the infarct? It is impossible to conclude from this that the infarct was VERY large, though it likely was very large since the time to intervention was long.

Myocardial Infarction 122

Myocardial Infarction Critical Care Echocardiogram Ischemia 122

Circulation

FEBRUARY 12, 2024

The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events.

Ultrasound 67

Ultrasound Myocardial Infarction Thrombosis Stent 67

Dr. Smith's ECG Blog

JUNE 27, 2021

If this STD were due to LVH or to subendocardial ischemia, rather than posterior OMI, it would be maximal in V5 and V6. If I saw this without the STD V2-V4, I would not make anything of it, and even with that precordial STD, I am not convinced that it is a manifestation of ischemia. This is a HUGE myocardial infarction.

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Important point: when there is diffuse subendocardial ischemia but no OMI, a wall motion abnormality will not necessarily be present. They agreed ischemia was likely in the setting of demand given DKA and infection. That this is all demand ischemia is unlikely. Lung exam showed diffuse B lines bilaterally. Aslanger's pattern.

Chest Pain 119

Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

Dr. Smith's ECG Blog

JANUARY 2, 2016

There may be ischemia present, but it is not evident on the ECG. In this paper, Dr. Birnbaum writes: "In patients with ACS without LVH, ST depression with negative T waves in the lateral leads is a sign of sub-endocardial ischemia and is an independent predictor of adverse outcome [11 – 13]. Notice the S-wave in V2 is 45 mm.

Ischemia 52

Ischemia Chest Pain STEMI Myocardial Infarction 52

Circulation

NOVEMBER 13, 2024

Advances in cardiovascular imaging have improved the ability to identify coronary artery stenosis in patients with KD, yet knowledge gaps remain regarding optimal frequency of serial imaging and the best imaging modality to identify those at risk for inducible myocardial ischemia.

Aneurysm 81

Aneurysm Myocardial Infarction Cardiovascular Imaging Ischemia 81

Dr. Smith's ECG Blog

MAY 20, 2024

This EKG is diagnostic of transmural ischemia of the inferior wall. Smith: note also the terminal QRS distortion in lead III (absence of S-wave without a prominent J-wave). . __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand).

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

Frontiers in Cardiovascular Medicine

JANUARY 22, 2024

Myocardial ischemia may induce myocardial fibrosis, a condition that progressively leads to ventricular remodeling, heightening the risk of heart failure. The timely detection of myocardial fibrosis is crucial for intervention and improved outcomes. The results demonstrated tracer-specific uptake (SUVmax = 4.6)

Angina 69

Angina Ischemia Myocardial Infarction Electrocardiogram 69

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

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. First , there can simply be diffuse ST depressions (which obligates reciprocal STE in aVR) associated with tachycardia which are not indicative of ischemia.

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Journal of Cardiovascular Pharmacology

NOVEMBER 16, 2023

Abstract: N(6)-methyladenosine (m6A) methylation modification is involved in the progression of myocardial infarction (MI). The ischemia/reperfusion (I/R) injury mouse model and hypoxia/reoxygenation (H/R) cell model were established. The results provided a theoretical basis that ALKBH5 is a potential target for MI treatment.

Myocardial Infarction 40

Myocardial Infarction Cardiac Function Ischemia Article 40

Becker's Hospital Review - Cardiology

JANUARY 30, 2025

Martha Gulati, MD, director of preventive cardiology in the department of cardiology at Los Angeles-based Cedars-Sinai's Smidt Heart Institute has raised awareness of two heart conditions needing better diagnostic tools ischemia with no obstructive coronary arteries and myocardial infarction with no obstructive coronary arteries.

Myocardial Infarction 52

Myocardial Infarction Ischemia 52

Coronary Artery Disease Journal

MARCH 7, 2024

Background Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44–0.83)

Myocardial Infarction 40

Myocardial Infarction Ischemia Thrombosis Stent 40

Dr. Smith's ECG Blog

MARCH 31, 2024

V5-V6) of any amplitude, is specific for Occlusion Myocardial Infarction (vs. non-occlusive ischemia) Ongoing ischemic symptoms in NSTEMI is already an indication for emergent cath, regardless of the ECG. Sometimes posterior leads help, and sometimes they falsely reassure.

Chest Pain 111

Chest Pain STEMI Ischemia Myocardial Infarction 111

DAIC

JUNE 25, 2024

This AI technology can detect 35 cardiac determinations (14 arrhythmias and 21 morphologies), including serious conditions like acute myocardial infarction ( MI ) and the most common types of cardiac ischemia, using a reduced leadset. KAI 12L employs multiple deep neural network algorithms, trained and validated on more than 1.75

Technology 116

Technology Heart Attack Heart attacks Innovation 116

CardiacWire

MAY 10, 2024

FFRCT analysis revealed high rates of asymptomatic lesion-specific coronary ischemia (65%), severe ischemia (52%), multivessel ischemia (36%), and left main ischemia (8%). Meanwhile, the usual care group’s coronary ischemia statuses remained unknown (because they didn’t test for it).

Coronary Artery Disease 59

Coronary Artery Disease Peripheral Arterial Disease Ischemia Myocardial Infarction 59

Frontiers in Cardiovascular Medicine

MAY 19, 2024

Myocardial infarction is among the top causes of mortality worldwide. Infarct-related torsade de pointes (TdP) is an uncommon complication. In the context of myocardial infarction, coronary artery bypass graft (CABG) surgery is the prevalent therapeutic modality associated with several early and late complications.

Coronary Artery Bypass Graft 52

Coronary Artery Bypass Graft Myocardial Infarction Arrhythmia Ischemia 52

Journal of Cardiothoracic Surgery

APRIL 11, 2024

A 53-year-old male presenting emergently with signs of myocardial infarction received immediate coronary angiography and thoracic CT-scan showing occlusion of the first marginal coronary branch without possibility of revascularization and minimal pericardial extravasation.

Ischemia 52

Ischemia Myocardial Infarction ICU Aortic 52

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

See these 2 articles Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study Author links open overlay panel [link] 1 Background We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury.

Chest Pain 119

Chest Pain STEMI Myocardial Infarction Electrocardiogram 119

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].

Ischemia 40

Ischemia Myocardial Infarction Thrombosis Strokes 40

Frontiers in Cardiovascular Medicine

AUGUST 7, 2024

This article evaluates the utility of S100A8/A9 protein as a biomarker and therapeutic target for diagnosing cardiovascular diseases, considering its structural features, fundamental biological properties, and its multifaceted influence on cardiovascular conditions including atherosclerosis, myocardial infarction, myocardial ischemia/reperfusion injury, (..)

Cardiovascular Disease 52

Cardiovascular Disease Myocardial Infarction Atherosclerosis Biomarkers 52

DAIC

DECEMBER 27, 2023

His research is focused on cell death, particularly as it relates to heart disease. Davis Heart and Lung Research Institute.

Heart Attack 111

Heart Attack Heart attacks Research Myocardial Infarction 111

Journal of the American Heart Association

DECEMBER 29, 2023

BackgroundFerroptosis, an iron‐dependent form of regulated cell death, is a major cell death mode in myocardial ischemia reperfusion (I/R) injury, along with mitochondrial permeability transition‐driven necrosis, which is inhibited by cyclosporine A (CsA). Journal of the American Heart Association, Ahead of Print.

Ischemia 40

Ischemia Myocardial Infarction 40

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

The first ECG was labeled “anterior subendocardial ischemia”, but subendocardial ischemia does not localize. If there were diffuse ischemic STD, with precordial STDmaxV5-6 and reciprocal STE-aVR, this would be non-specific subendocardial ischemia from ACS or supply-demand mismatch.

Chest Pain 114

Chest Pain STEMI Atrial Flutter Ischemia 114

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). Mechanical complications secondary to myocardial infarction are infrequent due to most patients receiving revascularization quite rapidly.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

JANUARY 4, 2021

This suggests diffuse subendocardial ischemia. However, along with that subendocardial ischemia, there is also STE in lead III with reciprocal ST depression in aVL, and some STE in V1. If there is also subendocardial ischemia, the ST depression vector remains leftward, with a reciprocal ST Elevation vector also to the right.

Ischemia 40

Ischemia Pulmonary STEMI Chest Pain 40

Dr. Smith's ECG Blog

MARCH 9, 2013

For those who depend on echocardiogram to confirm the ECG findings of ischemia, this should be sobering. In this case, the duration of ischemia was so brief that there was no such evolution, and there was near-normalization. Wellens' syndrome represents a state of reperfusion of the infarct related artery 2. Lessons: 1.

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia Angina 52

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) This session offers more insights from key clinical trials presented at ACC.24 24 and find out what it all means for your patients.

Aortic valve 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

DAIC

JULY 18, 2024

Cardiovascular disease is the most common cause of death and disability globally, largely driven by myocardial infarction and ischemic stroke caused by atherosclerosis (plaque build-up in the arteries).

Plaque 105

Plaque Heart Attack Heart attacks Cardiovascular Disease 105

DAIC

APRIL 2, 2025

The primary endpoint was the one-year rate of target vessel failure, the composite occurrence of either cardiac death, target-vessel myocardial infarction, or ischemia-driven target-vessel revascularization.

Stents 40

Stents Stent Outcomes Coronary Angiogram 40