Dr. Smith's ECG Blog

JANUARY 4, 2021

This suggests diffuse subendocardial ischemia. However, along with that subendocardial ischemia, there is also STE in lead III with reciprocal ST depression in aVL, and some STE in V1. If there is also subendocardial ischemia, the ST depression vector remains leftward, with a reciprocal ST Elevation vector also to the right.

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Ischemia Pulmonary STEMI Chest Pain 40

Dr. Smith's ECG Blog

MAY 20, 2024

This EKG is diagnostic of transmural ischemia of the inferior wall. If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. Transmural ischemia (as seen with the OMI findings on ECG) is not very common with demand ischemia, but is possible.

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

Dr. Smith's ECG Blog

MARCH 26, 2024

There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Aslanger's is a combination of acute inferior OMI plus subendocardial ischemia, and due to the ischemia vectors , it has STE only in lead III. Moreover, there is tachycardia.

Chest Pain 69

Chest Pain Embolism Pulmonary Ischemia 69

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Xray was consistent with pulmonary vascular congestion. Important point: when there is diffuse subendocardial ischemia but no OMI, a wall motion abnormality will not necessarily be present. They agreed ischemia was likely in the setting of demand given DKA and infection. That this is all demand ischemia is unlikely.

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was transported to the CCU for further medical optimization where a pulmonary artery catheter was placed. 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.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

MIBHS

OCTOBER 31, 2024

This may result in ischemia (lack of oxygen to the heart muscle), causing parts of the heart to weaken and enlarge. Chronic Pulmonary Disease Lung diseases like chronic obstructive pulmonary disease (COPD) can lead to pulmonary hypertension, which in turn can cause the right side of the heart to enlarge, a condition known as cor pulmonale.

Blood Pressure 52

Blood Pressure Blood Clot Heart Valves Heart Rhythm 52

Heart 2023 Conference

APRIL 20, 2022

Source: JAMA Cardiology) Patients with afib who survived an intracerebral haemorrhage had a very significant risk of cerebrovascular ischemia episodes and death in the following year, according to registry data. JACC: Asia) Lexaria Bioscience has announced that a CBD product beats a placebo in simulating acute pulmonary hypertension.

Pulmonary 52

Pulmonary Hypertension AFIB COVID-19 52

DAIC

MAY 16, 2024

If left untreated, PAD may progress to severe forms known as chronic limb-threatening ischemia (CLTI) and acute limb ischemia (ALI). It has been estimated that less than 5% of patients with PAD in the U.S. are prescribed to participate in a supervised exercise program.”

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Peripheral Arterial Disease Exercise Ischemia Quality of Life 105

Dr. Smith's ECG Blog

JANUARY 22, 2020

This middle-aged patient presented with SOB, weakness, and mild pulmonary edema. There was no evidence of ischemia. In addition to ruling out rate-slowing medication serum electrolyte disorders and/or ischemia/infarction as potential causes of bradyarrhythmias one should also rule out hypothyroidism + sleep apnea.

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Pulmonary AFIB Atrial Fibrillation Pacemaker 52

Dr. Smith's ECG Blog

JUNE 27, 2021

If this STD were due to LVH or to subendocardial ischemia, rather than posterior OMI, it would be maximal in V5 and V6. To me, this looks like pulmonary edema. B-line predominance bilateral lungs indicates pulmonary edema. B-line predominance bilateral lungs indicates pulmonary edema. Here are a few clips.

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is normal R-wave progression in the precordial leads with no evidence of ischemia. large ASD, partial anomalous pulmonary venous return, significant tricuspid regurgitation, carcinoid valvular disease, etc,) 2) Conditions causing pressure overload of the RV. Any cause of pulmonary hypertension. What do you think?

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Pulmonary Tricuspid Chest Pain Cardiogenic Shock 116

Dr. Smith's ECG Blog

JANUARY 20, 2024

CT pulmonary angiogram (unnecessary, often done while missing OMI) was unremarkable. Instead, pain is numbed and thus ischemia is obscured with opioids, excuses like hypertension are blamed, and unnecessary CT pulmonary angiograms are focused on. Which is true. No repeat ECG was done at this time.

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Chest Pain STEMI Hypertension Blog 121

Dr. Smith's ECG Blog

JANUARY 2, 2025

CT of the chest showed no pulmonary embolism but bibasilar infiltrates. It should be kept in mind that on occasions, beta-one agonist can result in increased ventricular ectopy e.g., in severe myocardial ischemia (by increasing myocardial demand), or sometimes with congenital long-QT syndrome. She was intubated.

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Tachycardia Cardiomyopathy Blog Bradycardia 116

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This usually represents posterior OMI, but in tachycardia and especially after cardiac arrest, this could simply be demand ischemia, residual subendocardial ischemia due to the low flow state of the cardiac arrest. This rules out subendocardial ischemia and is diagnostic of posterior OMI. V4-5 continue to show STD.

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Cardiac Arrest STEMI Ischemia SCAD 110

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Alternation in ST segment appearance ( or in the amount of ST elevation or depression ) — is often linked to ischemia. Conduction and refractoriness alternans may be seen with WPW-related as well as AV Nodal-dependent reentr y tachycardias — atrial fibrillation — acute pulmonary embolus — myocardial contusion — and severe LV dysfunction.

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Tachycardia Cardiac Arrest ICU Blog 131

Ken Grauer, MD

JUNE 6, 2023

Part of the ST depression with deep T wave inversion in the lateral chest leads clearly reflects LV "strain" from the marked LVH — but despite the very large QRS amplitudes, this ST-T wave appearance looks disproportionate, suggesting at least a component of ischemia. Then there is the significant ST elevation we see in lead V1.

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Blog Pulmonary Hypertension Aortic 78

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.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

All About Cardiovascular System and Disorders

MARCH 26, 2024

Transcript of the video: Eisenmenger syndrome is an important complication of large left to right shunts which develop later due to development of pulmonary vascular obstructive disease and severe pulmonary hypertension. So in ASD Eisemenger, suprasystemic pulmonary hypertension is possible. But, leave that alone.

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VSD Pulmonary Hemorrhage Hypertension 52

Dr. Smith's ECG Blog

DECEMBER 15, 2015

There is ST depression beyond the end of the wide QRS in I, II, aVF, and V4-V6, diagnostic of with subendocardial ischemia. It makes pulmonary embolism (PE) very likely. The small LV implies very low LV filling pressures, which implies low pulmonary venous pressure. Possible, but huge pulmonary embolism is more likely.

STEMI 40

STEMI Embolism Pulmonary Ultrasound 40

Journal of the American Heart Association

MARCH 21, 2025

Study end points include mortality, cardiovascular events (hospitalization for acute myocardial infarction or stroke) and limb events (hospitalization for critical limb ischemia or major amputation) and were identified using Veterans Affairs and nonVeterans Affairs encounters.ResultsThe mean age was 70.6 were male, and 18.5% At 1 year, 9.4%

Peripheral Arterial Disease 45

Peripheral Arterial Disease Outcomes Myocardial Infarction Kidney Disease 45

Dr. Smith's ECG Blog

JUNE 11, 2011

After resolution, there was T-wave inversion in V1-V3, highly suggestive of ischemia. There are features of the T-wave inversion, however, which argue against ischemia. Also, anterior ischemia is unlikely to spare lead V4 as in this case. This phenomenon is poorly understood, but involves "transient electrical remodeling."

Chest Pain 52

Chest Pain Ischemia STEMI Tachycardia 52

Frontiers in Cardiovascular Medicine

FEBRUARY 29, 2024

Postoperative complications included cerebral infarction (4.08%), acute renal insufficiency (30.61%), pulmonary insufficiency and need for ventilator (6.12%), poor wound healing (2.04%), postoperative reoperation (16.33%), and lower limb ischemia (2.04%).

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Aortic Quality of Life Stents Stent 49

Dr. Smith's ECG Blog

FEBRUARY 18, 2012

There was some pulmonary edema. This is typical for subendocardial ischemia, not STEMI, and often means left main ischemia or 3 vessel ischemia. They texted me the following ECGs, which I viewed in the shade of a pine tree on a glorious sunny snowy landscape. AT&T surprised me with their reach.

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STEMI Ischemia Chest Pain Stents 52

Dr. Smith's ECG Blog

MARCH 27, 2023

--The STD in V2-V6 might be interpreted as subendocardial ischemia, but with the inferior STE, it is far more likely to represent posterior OMI. In subendocardial ischemia, cath lab is indicated if the pain persists in spite of medical therapy (aspirin, anticoagulant, IV nitro). At 100 minutes, the above ECG was recorded.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

APRIL 27, 2012

He had a history of pulmonary embolism but was no longer on coumadin and states the pain is different. Here are V1-V3 from the last 3 ECGs: It is now clear that there is cardiac ischemia. 56 y/o male who presented with 12/10 severe chest pain starting at 3AM, radiating to his upper back. Wraparound? It was negative.

Chest Pain 52

Chest Pain Embolism Ischemia Pulmonary 52

Circulation

OCTOBER 21, 2024

Ischemia assays were used to examine the cell capacity for vascular malformation. This new population was referred to as arterial-lymphatic-like ECs according to its cellular markers, and its appearance was validated in the pulmonary small arteries afterAlk1deletion. Transplantation of these cells caused vascular malformations.

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Hemorrhage Transplant Ischemia Pulmonary 40

Dr. Smith's ECG Blog

APRIL 9, 2023

remain hypo- or akinetic for some time even if not infarcted, just due to the profound ischemia incurred during the occlusive phase. Thus, an acute wall motion abnormality is not a sign of active or persistent ischemia, and thus is not necessarily an indication for emergent cath. Even many NOMI have wall motion abnormalities.

Chest Pain 52

Chest Pain Ischemia Stenosis Pulmonary 52

Dr. Smith's ECG Blog

DECEMBER 24, 2023

And superimposed subendocardial ischemia pattern, of course. Smith's ECG Blog — the presence of an almost “null vector” in standard lead I ( ie, P wave, QRS complex and T wave all under 2mm in size ) — is highly suggestive of longstanding and severe pulmonary disease. She was otherwise very stable during this rhythm.

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Atrial Flutter Blog Aortic Aortic valve 127

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.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Circulation

NOVEMBER 11, 2024

Advanced cardiac imaging especially in atypical presentations, can aid in early diagnosis.Case:A 59 year-old man with history of biopsy-proven pulmonary sarcoidosis presented with non exertional chest pain for 2 months. Stress echocardiogram ruled out myocardial ischemia.

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Chest Pain Echocardiogram Document Ischemia 40

Dr. Smith's ECG Blog

AUGUST 14, 2023

The bedside echo showed a large RV (Does this mean there is a pulmonary embolism as the etiology?) The flutter waves can conceal or mimic ischemic repolarization findings, but here I don't see any obvious findings of OMI or subendocardial ischemia. Obviously he has multiple reasons to have pulmonary hypertension.

Chest Pain 52

Chest Pain Pulmonary Sickle Cell Disease Atrial Flutter 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Q waves in association with RBBB are usually not seen in anterior leads unless there is pulmonary hypertension or anterior infarction. Chest trauma was suspected on initial exam.

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Tachycardia Dysrhythmia Atrial Fibrillation Bradycardia 115

Dr. Smith's ECG Blog

APRIL 26, 2017

Low LV filling pressures are due to several etiologies, most commonly due to volume depletion (dehydration or hemorrhage), but also due to other etiologies including, but not limited to: mitral stenosis, pulmonary hypertension (chronic, or due to pulmonary embolism), or poor RV performance.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

Dr. S. Venkatesan MD

DECEMBER 29, 2023

A subset of NSTEMI precipitated by acute severe HT and flash pulmonary edema has excellent prognosis if BP is reduced promptly. Global ST depression (AVR.V1 might show little elevation with considerable overlap of left main STEMI vs NSTEMI ) 2.Onset Onset of NSTEMI-CS occurs late (48-72 hrs) 3.Severe

Cardiogenic Shock 52

Cardiogenic Shock STEMI Myocardial Infarction Document 52

All About Cardiovascular System and Disorders

OCTOBER 26, 2023

They include myocardial ischemia, acute pericarditis, pulmonary embolism, external compression due to mass over the right ventricular outflow tract region, and metabolic disorders like hyper or hypokalemia and hypercalcemia. According to a recent systematic review and meta-analysis, spontaneous type 1 ECG had 2.4%

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Sudden Cardiac Death Atrial Fibrillation Electrophysiology Arrhythmia 52

All About Cardiovascular System and Disorders

APRIL 13, 2024

Clinical evaluation and X-Ray chest showed features of pulmonary edema. ST segment elevation in aVR in proximal LAD occlusion before first septal is thought to be due to transmural ischemia of the basal part of the septum. ST segment elevation is noted in aVR.

Stenosis 52

Stenosis Coronary Artery Bypass Graft Coronary Artery Disease Document 52

Dr. Smith's ECG Blog

APRIL 22, 2019

It does not usually represent subendocardial ischemia, but rather it is usually reciprocal ST depression, reciprocal to inferior ST elevation. There are many potential causes of ST-T wave abnormalities (ie, LV “strain” from LVH; medication effect; electrolyte disturbance; pulmonary embolus, etc.). Sounds like reflux, right?

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Chest Pain Arrhythmia Ischemia STEMI 52