Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. You can see in the lead-specific analysis that she "sees" the STD in V5, V5, and II, with STE in aVR as signs of "Not OMI", because subendocardial ischemia pattern is not the same as OMI. In my opinion, I think it looks more like subendocardial ischemia. Am J Emerg Med.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

The ECG in the chart was read as "no obvious ST changes," (even though no previous ECG was available) and the formal read by the emergency physicians was: "ST deviation and moderated T-wave abnormality, consider lateral ischemia." When the ischemia is resolved, the wall motion may completely recover, or there may be persistent stunning.

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Chest Pain Thrombosis Myocardial Infarction STEMI 52

DAIC

OCTOBER 16, 2024

The study was carried out across 11 centers in the Netherlands, enrolling 741 patients at high risk of both bleeding and ischemia, making it one of the most comprehensive trials in this high-risk population. and 17.1%, respectively (P=0.02 for noninferiority).

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Stents Stent Thrombosis Coronary Artery Disease 52

Coronary Artery Disease Journal

MARCH 7, 2024

Background Untreated multivessel disease (MVD) in acute myocardial infarction (AMI) has been linked to a higher risk of recurrent ischemia and death within one year. The immediate non-IRA PCI is associated with a significantly lower occurrence of unplanned ischemia-driven PCI (OR 0.60; confidence interval [CI] 0.44–0.83)

Myocardial Infarction 40

Myocardial Infarction Ischemia Thrombosis Stents 40

EMS 12-Lead

JULY 24, 2023

It should be known that each category can easily manifest the generic subendocardial ischemia pattern. In general, subendocardial ischemia is a consequence of global supply-demand mismatch that usually ameliorates upon addressing, and mitigating, the underlying cause. What’s interesting is that the ECG can only detect ischemia.

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Angina Ischemia Coronary Angiogram Stenosis 52

Ken Grauer, MD

SEPTEMBER 21, 2024

These include coronary artery spasm ( as may be precipitated by cocaine use or binge alcohol drinking ) — myocardial bridging ( that may be the cause of intermittent acute ischemia ) — aberrant anatomy of a coronary artery ( which may present with sudden rupture causing acute infarction or sudden death at any age! ).

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Chest Pain Blog Thrombosis Tachycardia 118

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

His response: “subendocardial ischemia. Smith : It should be noted that, in subendocardial ischemia, in contrast to OMI, absence of wall motion abnormality is common. With the history of Afib, CTA abdomen was ordered to r/o mesenteric ischemia vs ischemic colitis vs small bowel obstruction. Anything more on history?

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Ischemia STEMI Stenosis Chest Pain 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.

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Pulmonary Hypertension AFIB COVID-19 52

Stroke Journal

FEBRUARY 1, 2024

While typically protective, these pathways may also promote pathologic thrombosis, which is a leading cause of death and disability. In addition to the possibility of microvascular ischemia, persistent microclots alter erythrocyte structure and may also entrap other proteins and stimulate production of various autoantibodies.

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Thrombosis Ischemia Stroke Strokes 40

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

I would expect TIMI-3 flow (normal flow, no persistent ischemia) with a culprit in the RCA (or possibly Circumflex). The angiogram showed an open artery with 95% stenosis and thrombosis and it was stented. What would I expect the angiogram to show? I would expect that a stent would be placed.

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Chest Pain STEMI Stents Stent 98

All About Cardiovascular System and Disorders

APRIL 21, 2024

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. It recalculates SYNTAX score by incorporating ischemia producing lesions determined by FFR. Normal FFR is 1.0 and an FFR below 0.75 An FFR below 0.75

Myocardial Infarction 52

Myocardial Infarction Stents Stent Coronary Artery Disease 52

Stroke Journal

FEBRUARY 1, 2024

Von Willebrand factor (VWF) plays a crucial role in hemostasis and thrombosis by promoting platelet adhesion to the subendothelial matrix and factor VIII stabilization. aureus-infected WT,Vwf-/-,Adamts13-/-mice were subjected to transient (30 min) middle cerebral artery ischemia using a filament model.

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Outcomes Stroke Strokes Thrombosis 40

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.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

MINOCA may be due to: coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli , and coronary dissection. link] We know that most type 1 acute MI due to plaque rupture and thrombosis occurs in lesions that are less than 50% (see Libby reference).

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Plaque Chest Pain Thrombosis Stenosis 52

EMS 12-Lead

MAY 20, 2022

There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This is the initial ECG: The QRS is widened with a regular cadence, and there are no discernable P waves.

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Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

We report this case to emphasize the importance of early consideration of ischemia as a differential diagnosis. CTA/CTV of the head was done and there was no evidence of vessel abnormalities or sinus thrombosis. Around a quarter of pediatric stroke patients will present with new onset seizures.

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Pediatrics Stroke Strokes Quality of Life 40

EMS 12-Lead

AUGUST 14, 2022

A second 12 Lead ECG was recorded: This is a testament to the dynamic nature of coronary thrombosis and thrombolysis. Accurate identification is absolutely necessary as this pattern can be easily misinterpreted for something less nefarious: for example, generic “subendocardial ischemia.” But the lesion is still active!

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STEMI Sudden Cardiac Death Thrombosis Thrombolysis 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). It was thought to be an in stent restenosis and thrombosis from a DES placed in the same region 6 months prior. In there ECG evidence of possible ongoing ischemia? (ie,

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

These include coronary artery spasm ( as may occur from cocaine use or binge alcohol drinking ) — myocardial bridging ( that may be the cause of intermittent acute ischemia ) — aberrant anatomy of a coronary artery ( which may present with sudden rupture causing acute infarction or sudden death at any age! ). Was this coincidence? —

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Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

For this analysis, ACO was defined as angiographic evidence of coronary thrombosis with peak cardiac troponin-I (cTn-I) at least 10 ng/mL or cTn-T ≥ 1 ng/ mL. There is no way the ST-T wave should change from lead V4-to-V5 as we see here given the similar all negative QRS appearance in these 2 leads, unless there is acute ischemia.

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Chest Pain Myocardial Infarction STEMI Ischemia 52

EMS 12-Lead

JUNE 20, 2022

Although the attending crews did not consider the ECG pathognomonic for occlusive thrombosis, they nonetheless considered the patient high-risk for ACS and implored him to reconsider. It’s important to stress the presence of a normal QRS (i.e., As the conversation progressed, another ECG spontaneously printed.

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STEMI Stents Stent Myocardial Infarction 52

DAIC

JANUARY 23, 2024

12,16 In 2017, CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) provided proof-of-principle that inflammation inhibition in the absence of lipid lowering can significantly reduce cardiovascular event rates and helped to define the interleukin-1 (IL-1) to IL-6 to CRP pathway as a central target in CV disease.16

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Cardiovascular Disease Heart Attack Heart attacks Coronary Artery Disease 111

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! Here is the final angiogram following placement of a stent in the ostial RCA. She was defibrillated perhaps 25 times.

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Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 75

Dr. Smith's ECG Blog

JANUARY 21, 2025

Time 7 hours lead reversal There is limb lead reversal (QRS in I and aVL are now inverted), but nevertheless one can see that the ischemia appears to have resolved. Negative trops and negative angiogram does not rule out coronary ischemia or ACS. Next day, with K = 4.6 mEq/L The QRS is still very wide. The evidence of OMI is gone.

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Chest Pain STEMI Tachycardia Myocardial Infarction 62