Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. Anything more on history?

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Ischemia STEMI Stenosis Chest Pain 52

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. I have seen cases of Wellens' syndrome that were ignored because of either negative troponins or normal echo or both and the patient did not get an angiogram and had a bad outcome. Wellen's syndrome is a Reperfusion syndrome.

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Chest Pain Myocardial Infarction Ischemia Angina 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

STE limited to aVR is due to diffuse subendocardial ischemia, but what of STE in both aVR and V1? The additional ST Elevation in V1 is not usually seen with diffuse subendocardial ischemia, and suggests that something else, like STEMI from LAD occlusion, could be present. Was this: 1) ACS with ischemia and spontaneous reperfusion?

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Cardiac Arrest Ischemia Defibrillator Electrocardiogram 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

Jason asked me if I thought it is due to occlusion (without either of us knowing the outcome), and this was my answer: This is a posterolateral MI. Down-up T-waves in inferior leads are almost always reciprocal to ischemia in the territory underlying aVL. This ECG is diagnostic of ischemia. LM: No significant stenosis.

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Ischemia Chest Pain STEMI Stenosis 40

Stroke Journal

FEBRUARY 1, 2024

Introduction:Cerebrovascular ischemia poses a substantial neurological threat due to cerebral artery constriction. DAPI analysis indicated ischemic animals displayed considerably fewer DAPI-stained cells, attesting to successful ischemia induction and ensuing damage. Stroke, Volume 55, Issue Suppl_1 , Page A154-A154, February 1, 2024.

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Ischemia Innovation Stenosis Stroke 40

DAIC

FEBRUARY 29, 2024

This year’s theme, “Advancing Cardiovascular Care for All” brings the latest practice-changing breakthroughs, along with top experts debating and discussing outcomes of highly-anticipated clinical trials. 24 from April 6 - 8, 2024 in Atlanta, GA at the Georgia World Congress Center. 24 and find out what it all means for your patients.

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Aortic valve Myocardial Infarction Aortic Blood Pressure 103

Dr. S. Venkatesan MD

SEPTEMBER 23, 2024

Likelihood of truth : High The flamboyant genius of Andreas Roland Gruntzig, from Zurich gifted us the path-breaking treatment modality for coronary stenosis five decades ago. Surprised and rejoiced to read this defiant article against ORBITA-2 from Impactful journal Circulation Cardiovascular Quality Outcomes. Come September 2024.

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Angina Academic Stenosis Article 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Rescue treatment with stenting, balloon angioplasty, and/or intraarterial thrombolysis or antiplatelets are often required to treat the underlying stenosis. ConclusionPTAS appears to be an effective and safe treatment for ICAD after MT in the posterior circulation both improving likelihood of good outcomes and overall survival.

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Stents Stent Circulation Stroke 40

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

The culprit lesion was a complex calcified mid LAD stenosis involving the first and second diagonal branches. Smith : the profound persistent STE suggests either persistent occlusion or " no reflow " with persistent downstream ischemia. Long term outcome unknown but obviously bleak. There was significant thrombus noted.

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STEMI Myocardial Infarction Ischemia Academic 78

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.

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Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

The patient’s angiogram should have been expedited, but the EKG change was not recognized as recurrence of transmural ischemia. The red arrow points to a 90% stenosis in the proximal segment of the LAD. The conventional computer algorithm called “ sinus tachycardia, otherwise normal EKG ”. RAO Caudal view: This is the RAO Caudal view.

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Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is normal R-wave progression in the precordial leads with no evidence of ischemia. COPD, Idiopathic PAH, acute or chronic PE, pulmonary valve stenosis, etc) 3) Conditions affecting RV myocardial contractility, such as ARVD or RV infarction The ECGs does not really show any signs of chronic RV dilation or hypertrophy.

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Pulmonary Tricuspid Chest Pain Cardiogenic Shock 116

Dr. Smith's ECG Blog

JULY 31, 2013

T-wave inversion in V2 is inconsistent with early repol, and is typical of posterior ischemia. In addition, there is ST depression, diagnostic of ischemia, in V3-V6. It showed a 99% stenosis in the RCA, and proximal to a posterolateral branch. mm of ST elevation in inferior leads. There should be no doubt that this is OMI.

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Chest Pain Aneurysm STEMI Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

1-4 Surprisingly, serial angiographic studies have revealed that the plaque at the site of the culprit lesion of a future acute myocardial infarction often does not cause stenosis that, as seen on the antecedent angiogram, is sufficiently severe to limit flow. There may be a chronic tight stenosis and a non-obstructed lesion that thrombosed.

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Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was Was the ST elevation due to transient demand ischemia, or is it false positive? It is highly associated with proximal LAD occlusion or severe left main ACS and with bad outcomes. Does he need a stress test? --Is

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STEMI Chest Pain Cardiac Arrest Stents 40

Dr. Anish Koka

MAY 16, 2023

Soviet biologist Trofim Lysenko famously rejected the objective reality of Mendelian genetics because it clashed with the Marxist philosophy that the environment, not genetics, was the primary determinant of outcomes. Marked differences can be seen in the prevalence of coronary artery stenosis at autopsy by age and gender.

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Chest Pain Coronary Artery Disease Cancer Heart Attack 52

Dr. Smith's ECG Blog

AUGUST 28, 2020

This is ischemia until proven otherwise. Here I annotate it: This shows 100% occluded circumflex (red arrow) and a 90% stenosis of the LAD (Yellow arrow). The LAD was thought to be not thrombotic, but a chronic tight stenosis. I learned that the patient is on Sotalol for control of PVCs. This explains the long QT.

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Cardiogenic Shock Chest Pain Ischemia Stenosis 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Angiogram showed a critical LAD thrombotic stenosis. The patient went to cath and had a distal LAD 99% stenosis with thrombus and TIMI-2 flow. 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. He underwent CABG.

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Chest Pain STEMI Bradycardia Stenosis 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). 90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX.

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Chest Pain Blog Stenosis Myocardial Infarction 52

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. EKG shown here: LAFB with no clear signs of OMI or ischemia. Queen of Hearts Interpretation: Would 20 minutes earlier diagnosis have made a difference in his clinical outcome?

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Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Full case details and outcomes are below. Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia." Ongoing ischemia despite medical management has always been an indication for emergent cath, which is frequently ignored as it was in this case. Case 1: Case 2: Case 1: What do you think?

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Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

If the patient had been "lucky," his symptoms from the prior day might have been due to ischemia prolonged and intense enough to result in small troponin increase. Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depressions. mm for women, 2.0 Pride et al.

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Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

Journal of the American Heart Association

FEBRUARY 27, 2024

We evaluated the primary outcome (cardiovascular death, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) and other end points, by sex, in 1168 (22.6%) women and 4011 (77.4%) men. of invasive‐assigned men, and no ≥50% stenosis in 12.3% of invasive‐assigned women and 74.8%

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Ischemia Coronary Artery Disease Myocardial Infarction Outcomes 45

Dr. Smith's ECG Blog

APRIL 8, 2015

Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Evidence of acute ischemia (may be subtle) vii. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS. Left BBB vi.

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Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

MARCH 3, 2025

The patient was started on heparin for possible NSTEMI vs demand ischemia. Smith : "decompensation" of aortic stenosis might have initiated this entire cascade. What "initiates" the aortic stenosis cascade? increasing stenosis, ischemia, volume changes, increased blood pressure, atrial fibrillation, etc.)

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Tachycardia Pulmonary Chest Pain Stenosis 74

Cardiometabolic Health Congress

JANUARY 2, 2025

August 2024 Approvals Minima Stent System (P240003) (Approval Date: August 28, 2024) The Minima Stent System is an expandable cobalt-chromium metal mesh tube to reopen blood vessels in neonates, infants, and children with Coarctation of the Aorta and Pulmonary Artery Stenosis, specifically designed to expand as younger patients grow.

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Coronary Artery Disease Stents Stent Innovation 52