Ischemia Pericarditis Stent 
Dr. Smith's ECG Blog
OCTOBER 8, 2023
The patient was referred immediately for cath which revealed RCA occlusion that was stented. Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There is ST depression in V1.
Dr. Smith's ECG Blog
JANUARY 28, 2018
More Smith comment: it is true that ST depression (STD) due to subendocardial ischemia does not localize [it is usually diffuse ST depression, in multiple leads and not reciprocal to ST elevation in an opposite territory], this ST depression is different! Both were stented. Notice how useful serial ECGs are! mm ST depression in aVL.
Dr. Smith's ECG Blog
MARCH 11, 2016
It was treated with and dual "kissing balloons" and drug eluting stents. Here is the post stent ECG: There is greater than 50% resolution of ST elevation (all but diagnostic of successful reperfusion) and Terminal T-wave inversion (also highly suggestive of successful reperfusion). Myocardial Rupture and Postinfarction Pericarditis.
Dr. Smith's ECG Blog
FEBRUARY 29, 2016
Normal RBBB, no evidence of ischemia. It was opened and stented. Patients with completed, transmural infarct are also at risk for post-infarction regional pericarditis and myocardial rupture. In figure 3, I have inverted the image vertically to simulate recording leads from the opposite polarity (see Figure 3 ).
Dr. Smith's ECG Blog
JUNE 28, 2019
60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. Pericarditis? It was stented. A straight ST segment virtually never happens in inferior ST elevation that is NOT due to OMI (normal variant, pericarditis) 4. The patient had a p rior h istory of MI + stents.
Dr. Smith's ECG Blog
NOVEMBER 1, 2022
The 50-something patient with history of coronary stenting and slightly reduced LV ejection fraction. In the setting of prior stenting and reduced left ventricular ejection fraction, would pursue a heart team revascularization approach Syntax score 28.5, Pericarditis would be even more unlikely in someone without chest pain.
Dr. Smith's ECG Blog
AUGUST 6, 2024
In any case, the ECG is diagnostic of severe ischemia and probably OMI. These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. Nossen Comment/Interpretation: Evaluation of ischemia on an ECG can be very challenging. Concordant STE of 1 mm in just one lead or 2a.
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