Remove Ischemia Remove Plaque Remove Risk Factors
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

This EKG is diagnostic of transmural ischemia of the inferior wall. The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). Lead I also shows reciprocal ST depression.

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

Dr. Smith's ECG Blog

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.

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"A patient just arrived as a transfer for NSTEMI."

Dr. Smith's ECG Blog

I quickly reviewed the patient’s records and saw that she was a 53 year old woman with a history of BMI 40, but no other identifiable risk factors for coronary artery disease. This proves effective treatment of the recurrent ischemia. The patient had no further symptoms of ischemia. I performed bedside echocardiography.

SCAD 124
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Critical Left Main

EMS 12-Lead

Given the consistency of the clinical profile with typical angina, associated risk factors, and abnormal ECG findings, a cardiology consult was promptly requested. It should be known that each category can easily manifest the generic subendocardial ischemia pattern. What’s interesting is that the ECG can only detect ischemia.

Angina 52
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American College of Cardiology ACC.24 Late-breaking Science and Guidelines Session Summary

DAIC

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.

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Chest Pain in a Male in his 20's; Inferior ST elevation: Inferior lead "early repol" diagnosed. Is it?

Dr. Smith's ECG Blog

No thromboembolism risks, not pleuritic, no radiation to the back. No cardiac risk factors, no cocaine use. 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. History: Onset of CP 2.5

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An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

She had zero CAD risk factors. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point. hours of substernal chest pressure.

SCAD 52