Dr. Smith's ECG Blog

NOVEMBER 19, 2016

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. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.

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Ischemia Cardiogenic Shock Aortic Stenosis 40

DAIC

JULY 18, 2024

The company is also pursuing an indication for non-invasive measurement of fractional flow reserve (FFR CT ), uniquely derived from its plaque algorithm, to measure coronary blockages and the extent of ischemia.

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Plaque Heart attacks Heart Attack Cardiovascular Disease 105

Dr. Smith's ECG Blog

JANUARY 9, 2024

Are you confident there is no ischemia? Primary VT , and the VT with tachycardia is causing ischemia with chest discomfort (supply-demand mismatch/type 2 MI)? Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Do you agree with this strategy? How can you better assess the ST segments?

Tachycardia 120

Tachycardia Electrophysiology Atrial Flutter Ischemia 120

Journal of the American Heart Association

JANUARY 23, 2025

BackgroundAcute psychological stress may induce physiological changes predisposing individuals to adverse health outcomes through hemodynamic and vascular effects. Journal of the American Heart Association, Ahead of Print.

Coronary Artery Disease 56

Coronary Artery Disease Outcomes Myocardial Infarction Risk Factors 56

Circulation

NOVEMBER 11, 2024

Endothelial cell (EC) sensing of elevated fluid shear stress (FSS) from blood flow induces vessel outward remodeling to restore physiological FSS, but mechanisms are poorly understood. In a mouse arteriovenous fistula (AVF) model, high FSS induces arterial outward remodeling coincident with elevated BMPER expression and Smad1/5 inactivation.

Physiology 40

Physiology Ischemia Diabetes Circulation 40

Stroke Journal

FEBRUARY 1, 2024

mm in diameter, 3 mm in length) containing zirconium dioxide was advanced in the catheter by injection of physiological saline to establish local occlusion. A blood clot (0.86 Both fluoroscopy at 1, 3, 6, 24 h and TTC staining at 24 h after stroke model creation were performed.

Blood Clot 40

Blood Clot Ischemia Embolism Physiology 40

Dr. Smith's ECG Blog

DECEMBER 26, 2020

We have also shown several cases in which atrial flutter hides true, active ischemia. Likewise, in some cases of ischemia concealed by flutter waves, the ischemia can be seen despite the flutter waves, whereas in other cases the dysrhythmia must be terminated before the ischemia can be clearly distinguished.

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Atrial Flutter Ischemia STEMI Tachycardia 52

Stroke Journal

JANUARY 30, 2025

Intro:Resources for studying stroke are limited to clinical trials with sparse access to physiological and biochemical details, and pre-clinical animal studies with limited relation to humans. A physiologically accurate in silico model would provide a new route for study of the response to an ischemic event.

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Stroke Strokes Physiology Ischemia 40

Journal of Cardiovascular Pharmacology

MARCH 13, 2024

Historical and ongoing research acknowledges the endocannabinoid system's crucial role in managing physiological processes, suggesting cannabinoids could offer therapeutic benefits in post-surgical recovery.

Open-Heart Surgery 40

Open-Heart Surgery Research Physiology Ischemia 40

Stroke Journal

FEBRUARY 1, 2024

Computational models of cerebrovascular ischemia are well-suited to such exploration, and the use of digital phantoms for sophisticated biophysical modeling has been facilitated by emergent hardware, software, and computational solutions.

Stroke 40

Stroke Strokes Ischemia Physiology 40

All About Cardiovascular System and Disorders

APRIL 21, 2024

But it need not imply the actual functional significance of the stenosis in terms of flow physiology. indicates inducible ischemia while an FFR above 0.80 excludes ischemia in 90% of cases. There is a strong correlation between FFR and inducible myocardial ischemia. identified physiologically significant stenosis.

Myocardial Infarction 52

Myocardial Infarction Stent Stents Coronary Artery Disease 52

Dr. Smith's ECG Blog

AUGUST 4, 2024

Serial echo monitoring showed increasing pericardial pressures without overt tamponade physiology. That said — I did not interpret these differences as the result of acute ischemia. Echo showed a new large pericardial effusion with large focal hematoma in the posterior pericardium near the descending thoracic aorta/TEVAR edge.

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Pericarditis Chest Pain Blog Aortic 117

Dr. Smith's ECG Blog

OCTOBER 10, 2022

In terms of ischemia, there is both a signal of subendocardial ischemia (STD max in V5-V6 with reciprocal STE in aVR) AND a signal of transmural infarction of the inferior wall with Q wave and STE in lead III with reciprocal STD in I and aVL. The rhythm is atrial fibrillation. The QRS complex is within normal limits. These include.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 6, 2024

In the days before I learned to look for OMI, back when I was counting ST elevation boxes, I used to save ischemia for last.) The atrial rate is around 120 beats per minute, which indicates high adrenergic state and physiologic distress! I interpret tracings systematically in "real time" ( including my assessment for acute ischemia ).

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Blog Ischemia Tachycardia STEMI 111

EMS 12-Lead

MAY 8, 2022

This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] Chapter 6: Introduction to Myocardial Ischemia and Infarction. Physiology. 2] Birnbaum, Y., 3] Costanzo, L.

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ACE Inhibitor Ischemia STEMI Physiology 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

The ECG was incorrectly interpreted as no signs of ischemia. Artificial intelligence can be trained to recognize subtle OMI = My Comment by K EN G RAUER, MD ( 2/6 /2023 ): = The initial ECG in today's case was incorrectly interpreted as, "No signs of ischemia". Figure-1: Comparison of the first 3 ECGs in today's case.

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Chest Pain Physiology Blog Stent 52

Dr. Smith's ECG Blog

JANUARY 23, 2024

Extensive conduction system abnormalities can have various causes (ischemia, genetic, infectious, amyloid, etc). The physiologic reason for this — is thought to be the result of momentarily increased circulation from mechanical contraction arising from the "sandwiched in" QRS complex. The QRS complex in ECG #1 is wide.

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Tachycardia Arrhythmia Heart Disease Sudden Cardiac Death 108

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And superimposed subendocardial ischemia pattern, of course. It simply does not make physiologic sense to suddenly see an all-negative QRS complex in this most lateral chest lead. Several minutes later there was a change in the monitor, and she reported increased palpitations: With the context, this is almost certainly 1:1 flutter.

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Atrial Flutter Blog Aortic Aortic valve 127

Dr. Smith's ECG Blog

OCTOBER 13, 2022

2] Conduction through the accessory pathway can be intermittent (with different degrees of pre-excitation), and affected by ischemia. 3] So a patient with WPW can have the pattern induced by ischemia, and there is also a report of a patient with pre-existing WPW which was “ablated” by myocardial infarction after an LAD occlusion.[4]

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia STEMI 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

Neuroadaptation after chronic cocaine use is less well understood though rat models suggest that as cerebral ischemia develops from chronic cocaine use, the HIF‐VEGF pathway is activated to promote angiogenesis to restore local blood flow[3].

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Physiology Ischemia Stenosis Stroke 40

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

This transmural ischemia, but not necessarily completed infarction (yet). See more images of this case at Gopal's Spectral CT Blog: It's all about confidence With continued symptoms, an elevated troponin, and no other explanation, this is acute MI with ongoing ischemia until proven otherwise.

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Chest Pain Blog Ischemia Article 52

Dr. S. Venkatesan MD

FEBRUARY 20, 2024

We wish, our understanding about cardiac contractile physiology is deep and nearly complete. The simple reason could be we can address the ischemia a potential arrhythmic target by some form of revascularization in IDCM. Heart is an irreversibly coupled electro-mechanical organ , right from the fetal days until the final heart beat.

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Defibrillator Heart Failure Sudden Cardiac Death Cardiomyopathy 52

Dr. Sanjay Gupta

MARCH 6, 2022

It is also unique because it works using the Doppler effect, you can get not only an anatomical evaluation of the heart but also physiological assessment. These are therefore not looking for coronary disease but instead ischemia heart disease. It is still possible to have ischemia without coronary disease.

Heart attacks 52

Heart attacks Heart Attack Heart Rhythm Exercise 52

Dr. S. Venkatesan MD

MARCH 19, 2024

It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC equivalent zone. What does it imply ?

Heart Valves 52

Heart Valves Blood Clot Heart Disease Bicuspid/Mitral 52

Dr. Smith's ECG Blog

APRIL 3, 2019

Pain will resolve with completed infarct or with resolution of ischemia. ECG recorded at 7 hours All active ischemia is gone. Pain will resolve not just with resolution of ischemia, but with completion of infarction. This T wave progression sequence does not make physiologic sense. This looks like infarct completion.

STEMI 40

STEMI Chest Pain Ischemia Aneurysm 40

Dr. Smith's ECG Blog

APRIL 20, 2019

V2 never has this appearance in the absence of full thickness ischemia. There is a small amount of reciprocal STD in V6 with a negative T-wave. This is subtle but diagnostic for anterior Occlusion MI. We called for emergent cath lab activation. The cardiologist arrived quickly and was skeptical about these findings on EMS ECG.

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STEMI Chest Pain ECG Technician Physiology 52

Dr. Smith's ECG Blog

DECEMBER 5, 2022

I thought the dramatic increase in chest lead amplitudes ( ie, very deep S waves in anterior leads — with very tall R waves in V5,V6 ) — together with tall, peaked anterior T waves — and QTc prolongation with deep symmetric T wave inversion in V5,V6 — could all be explained by marked LVH with LV “strain” and/or ischemia.

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Article Chest Pain Circulation Electrocardiogram 52

Ken Grauer, MD

MARCH 23, 2023

At about this point in the process — I like to take a closer LOOK at the 12-lead tracing, to ensure there is no acute ischemia or infarction that might need immediate attention. What about the 1 2- L ead E CG ? As already established — the QRS complex is narrow in all leads, so the rhythm is supraventricular. The QTc is not overly prolonged.

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Blog Tachycardia Arrhythmia Atrial Flutter 78

Dr. Smith's ECG Blog

OCTOBER 7, 2019

RCA ischemia often results in sinus bradycardia from vagal reflex or ischemia of the sinus node. Smith pointed out that while atropine may may result in slightly more oxygen demand, the increase in cardiac output and in blood pressure would increase overall coronary perfusion and decrease ischemia.

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Bradycardia Cardiogenic Shock STEMI Ischemia 40

Dr. Smith's ECG Blog

DECEMBER 18, 2022

If you still have not read it, I strongly recommend that you read the following article on the diagnosis of "posterior" MI: Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia), by Meyers HP et al. J Am Heart Assoc. doi: 10.1161/JAHA.121.022866.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Smith's ECG Blog

DECEMBER 27, 2018

The physiologic basis for the finding of LVH on ECG, is that with increases in left ventricular mass — electrical forces directed toward the LV ( left ventricle ) increase, and this produces larger R wave amplitude in one or more left-sided leads (ie, leads I, aVL, V4,5,6 ).

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

JULY 3, 2020

Either could be a result of myocardial contusion There is some minimal ST depression -- this could represent ischemia What else is there that could use therapy immediately? Or, much less likely, it could be a very accelerated escape rhythm from the posterior fascicle. There is a very long ST segment resulting in a very long QT.

Hemorrhage 52

Hemorrhage Critical Care Blood Pressure Laboratory 52

Journal of Clinical Investigation - Cardiology

JULY 1, 2024

Biological sex is an important modifier of physiology and influences pathobiology in many diseases. The heart is a remarkably plastic organ and rapidly responds to physiological and pathological cues by modifying form and function. Finally, we offer a perspective on key future directions for research into cardiac sex differences.

Physiology 52

Physiology Heart Disease Ischemia Research 52

Cardiometabolic Health Congress

MAY 10, 2024

In MSIMI (Mental Stress-induced Myocardial Ischemia) studies , mental stress activities like public speaking were evaluated for their impact on ischemia, measured via myocardial SPECT and vascular function (microvascular function, endothelial function).

Coronary Artery Disease 59

Coronary Artery Disease Obesity Chest Pain Ischemia 59

Dr. Smith's ECG Blog

APRIL 8, 2015

Evidence of acute ischemia (may be subtle) vii. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia. Fourth, syncope in the elderly often results from polypharmacy and abnormal physiologic responses to daily events. 2nd or 3rd degree AV blocks or sinus pause of at least 2 seconds iv.

Arrhythmia 52

Arrhythmia Outcomes Risk Factors Chest Pain 52

Ken Grauer, MD

FEBRUARY 1, 2025

But the definite ST segment flattening and depression in leads V4 , V5 , V6 is real and given the history of new severe CP this has to be assumed as acute ischemia until proven otherwise. Physiologically this may occur as a result of very brief coronary occlusion, followed so soon after by spontaneous reperfusion.

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Blog STEMI Physiology Ischemia 164

Dr. S. Venkatesan MD

FEBRUARY 4, 2025

The fact that the heart rate is normal rules out demand side ischemia as well. Interpretation of T-wave inversion in physiological and pathological conditions: Current state and future perspectives. In this case, it was taken in a 36-year-old woman, routine health check and has no specific symptom. Have seen a HCM variants like this ).TMT

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Echocardiogram Physiology Ischemia 52