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 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.

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Chest Pain Ischemia Stenosis Pulmonary 52

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.

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Chest Pain STEMI Ultrasound Pulmonary 52

Dr. Smith's ECG Blog

APRIL 15, 2019

But when the clinical presentation is sepsis, one must entertain the possibility that the ST elevation is due to demand ischemia, or some other process, and exacerbated by tachycardia. The estimated pulmonary artery systolic pressure is 37 mmHg + RA pressure. Normal estimated left ventricular ejection fraction lower limits of normal.

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Tachycardia STEMI Chest Pain Ischemia 40

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

JANUARY 20, 2024

CT pulmonary angiogram (unnecessary, often done while missing OMI) was unremarkable. Angiogram around 9am: Culprit lesion mid LAD 100% stenosis TIMI 0 TIMI 3 after PCI Severe apical dyskinesis, severe anteroapical akinesis. Triage ECG: And here she explains her assessment: The ECG was read as simply "No ST elevation." Which is true.

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Chest Pain STEMI Hypertension Blog 120

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

Dr. Smith's ECG Blog

MARCH 3, 2025

I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Anything that causes pulmonary edema: poor LV function, fluid overload, previous heart failure (HFrEF or HFpEF), valvular disease. The patient was started on heparin for possible NSTEMI vs demand ischemia.

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Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

APRIL 8, 2015

Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Evidence of acute ischemia (may be subtle) vii. heart auscultation (aortic stenosis); c. ST segment and T wave abnormalities consistent with or possibly related to myocardial ischemia. 2nd or 3rd degree AV blocks or sinus pause of at least 2 seconds iv.

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Arrhythmia Outcomes Chest Pain Risk Factors 52

Dr. Smith's ECG Blog

DECEMBER 6, 2024

Watch what happends as the heart recovers from its episode of ischemia. Angiogram: Severe two-vessel coronary artery disease of a left dominant system including 70 to 80% stenosis involving the distal left main/bifurcation. The ECG shows inferior ischemia. Are the T-waves in leads I and II hyperacute? Hard to tell.

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Coronary Artery Bypass Graft Ischemia Chest Pain Stenosis 107

Cardiometabolic Health Congress

JANUARY 2, 2025

August 2024 Approvals Minima Stent System (P240003) (Approval Date: August 28, 2024) The Minima Stent System is an expandable cobalt-chromium metal mesh tube to reopen blood vessels in neonates, infants, and children with Coarctation of the Aorta and Pulmonary Artery Stenosis, specifically designed to expand as younger patients grow.

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Coronary Artery Disease Stent Stents Innovation 52