Ischemia, Outcomes and Thrombosis - Cardiovascular Update

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies. And yet the arteries remain open.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

Abstract 19: Von Willebrand Factor Deficiency Improves Long Term Stroke Outcomes in Mice With Respiratory Infections

Stroke Journal

FEBRUARY 1, 2024

Von Willebrand factor (VWF) plays a crucial role in hemostasis and thrombosis by promoting platelet adhesion to the subendothelial matrix and factor VIII stabilization. aureus-infected WT,Vwf-/-,Adamts13-/-mice were subjected to transient (30 min) middle cerebral artery ischemia using a filament model. vs. mock-infected mice).S.

Outcomes

Outcomes Stroke Strokes Thrombosis

SMT Publishes Trial Results for Supraflex Cruz Stent

DAIC

OCTOBER 16, 2024

The study was carried out across 11 centers in the Netherlands, enrolling 741 patients at high risk of both bleeding and ischemia, making it one of the most comprehensive trials in this high-risk population. and 17.1%, respectively (P=0.02 for noninferiority). If you enjoy this content, please share it with a colleague

Stents

Stents Stent Thrombosis Coronary Artery Disease

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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

The baseline ECG is basically normal with no ischemia. You can see in the lead-specific analysis that she "sees" the STD in V5, V5, and II, with STE in aVR as signs of "Not OMI", because subendocardial ischemia pattern is not the same as OMI. In my opinion, I think it looks more like subendocardial ischemia. Am J Emerg Med.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

The ECG in the chart was read as "no obvious ST changes," (even though no previous ECG was available) and the formal read by the emergency physicians was: "ST deviation and moderated T-wave abnormality, consider lateral ischemia." When the ischemia is resolved, the wall motion may completely recover, or there may be persistent stunning.

Chest Pain

Chest Pain Thrombosis Myocardial Infarction STEMI

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

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

Ischemia

Ischemia STEMI Stenosis Chest Pain

Abstract 121: Misdiagnosis in a case of pediatric stroke

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

We report this case to emphasize the importance of early consideration of ischemia as a differential diagnosis. CTA/CTV of the head was done and there was no evidence of vessel abnormalities or sinus thrombosis. As a result, this helps better patient outcomes and avoids preventable morbidity and mortality.

Pediatrics

Pediatrics Stroke Strokes Quality of Life

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection. link] We know that most type 1 acute MI due to plaque rupture and thrombosis occurs in lesions that are less than 50% (see Libby reference).

Plaque

Plaque Chest Pain Thrombosis Stenosis

Intravascular Imaging Can Improve Outcomes for Complex Stenting Procedures

DAIC

APRIL 2, 2025

The ECLIPSE trial shows that use of IVI to guide coronary stenting in severely calcified lesions prevents death, stent thrombosis, and unplanned repeat procedures in this high-risk patient population. The ECLIPSE trial results were presented at the American College of Cardiology Scientific Session (ACC.25)

Stents

Stents Stent Outcomes Coronary Angiogram

Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography in the Guidance of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis.

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

Ultrasound Myocardial Infarction Thrombosis Stents

ECG Blog #448 — A Young Man with Chest Pain.

Ken Grauer, MD

SEPTEMBER 21, 2024

To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age." This may occur as a result of blunt chest trauma or other acute stress that produces a sudden extreme shear force on a coronary artery ( that can result in an intimal tear that leads to intraluminal thrombosis ).

Chest Pain

Chest Pain Blog Thrombosis Tachycardia

Fractional flow reserve for guiding coronary intervention and functional SYNTAX score

All About Cardiovascular System and Disorders

APRIL 21, 2024

indicates inducible ischemia while an FFR above 0.80 excludes ischemia in 90% of cases. Routine FFR measurement probably lead to more judicious use of stents and improved outcomes. There is a strong correlation between FFR and inducible myocardial ischemia. Normal FFR is 1.0 and an FFR below 0.75 An FFR below 0.75

Myocardial Infarction

Myocardial Infarction Stents Stent Coronary Artery Disease

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].

Ischemia

Ischemia Myocardial Infarction Thrombosis Stroke

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

DAIC

JANUARY 23, 2024

5 Over my career as a cardiovascular surgeon, as well as an immunologist, I have witnessed how current treatments for ASCVD have led to considerable improvements in outcomes, yet many patients remain vulnerable to life-threatening cardiac events.1,6 This in turn leads to an overall reduction in IL-6 production and CRP concentration.12

Cardiovascular Disease

Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

Smith Major Learning Point: The worst risk factor for a bad outcome in OMI is young age because cardiologists cannot believe that a young person can have an OMI. He was readmitted a few weeks later for a heart failure exacerbation, diuresed, and discharged again. This gets drilled into them. Was this coincidence? —

Chest Pain

Chest Pain Aneurysm STEMI Thrombosis

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Comments This appears to be a common misconception that MI cannot be diagnosed in paced rhythm. Wang asked readers for an interpretation.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Was her outcome to be expected for ostial RCA OMI? She was defibrillated perhaps 25 times. We will never know for certain.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Abstract 19: Von Willebrand Factor Deficiency Improves Long Term Stroke Outcomes in Mice With Respiratory Infections

SMT Publishes Trial Results for Supraflex Cruz Stent

Webinars

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Why we need continuous 12-lead ST segment monitoring in Wellens' syndrome

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Abstract 121: Misdiagnosis in a case of pediatric stroke

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Intravascular Imaging Can Improve Outcomes for Complex Stenting Procedures

Coronary Angiography, Intravascular Ultrasound, and Optical Coherence Tomography in the Guidance of Percutaneous Coronary Intervention: A Systematic Review and Network Meta-Analysis.

ECG Blog #448 — A Young Man with Chest Pain.

Fractional flow reserve for guiding coronary intervention and functional SYNTAX score

Abstract 087: Cocaine?Induced Acute Spinal Cord Ischemia Syndrome

Lowering Atherosclerotic Cardiovascular Disease Events by Treating Residual Inflammatory Risk

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

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