Myocardial Infarction, Plaque and Ultrasound

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Bedside cardiac ultrasound with no obvious wall motion abnormalities. Thus, it has recently become generally accepted that most plaque ruptures resulting in myocardial infarction occur in plaques that narrow the lumen diameter by 40% of the arterial cross section may be involved by plaque.

Ischemia

Ischemia Plaque Stenosis Myocardial Infarction

Exosomal circSCMH1/miR-874 ratio in serum to predict carotid and coronary plaque stability

Frontiers in Cardiovascular Medicine

DECEMBER 13, 2023

Background To investigate the correlation between lg (circSCMH1/miR-874) and acute coronary syndrome (ACS), acute myocardial infarction (AMI), and carotid plaque stability. Compared with the low-risk plaque and control groups, the lg (circSCMH1/miR-874) value of medium-high risk plaque group decreased ( P < 0.05).

Plaque

Plaque SCAD Coronary Artery Disease Myocardial Infarction

Tissue characterisation and primary percutaneous coronary intervention guidance using intravascular ultrasound: rationale and design of the SPECTRUM study

Open Heart

APRIL 18, 2022

Introduction Intravascular ultrasound (IVUS) improves clinical outcome in patients undergoing percutaneous coronary intervention (PCI) but dedicated prospective studies assessing the safety and efficacy of IVUS guidance during primary PCI are lacking.

Ultrasound

Ultrasound Myocardial Infarction Cardiovascular Imaging Plaque

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Bridging Innovation & Patient Care: The Growing Role of AI

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Imaging patients with myocardial infarction with non-obstructive coronary arteries (MINOCA)

Heart BMJ

JANUARY 10, 2024

Myocardial infarction with non-obstructive coronary arteries (MINOCA) defines a heterogeneous group of atherosclerotic and non-atherosclerotic conditions, causing myocardial injury in the absence of obstructive coronary artery disease.

Myocardial Infarction

Myocardial Infarction Coronary Artery Disease Ultrasound Plaque

Intravascular Imaging Can Improve Outcomes for Complex Stenting Procedures

DAIC

APRIL 2, 2025

and European societal guidelines that intravascular imaging with either optical coherence tomography (OCT) or intravascular ultrasound (IVUS) should be routinely used during complex coronary stent procedures, s ays first authorGregg W. These results extend the strong recommendations from recent U.S.

Stents

Stents Stent Outcomes Coronary Angiogram

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

Circulation

NOVEMBER 11, 2024

Background:The no-reflow has been reported to be associated with larger infarct size and mortality after acute myocardial infarction (AMI). The incidence of no-reflow was higher in patients with attenuated plaque ≥5 mm in length as evaluated by intravascular ultrasound (IVUS).Objective:The vs. 25.5%, p = 0.032).

Ultrasound

Ultrasound Plaque Blood Pressure Myocardial Infarction

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

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. MINOCA I do not have the bandwidth here to write a review of MINOCA.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

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

DAIC

FEBRUARY 29, 2024

ET Main Tent (Hall B1) - A Double-blind, Randomized Placebo Procedure-controlled Trial of an Interatrial Shunt in Patients with HFrEF and HFpEF: Principal Results From the RELIEVE-HF Trial - Empagliflozin After Acute Myocardial Infarction: Results of the EMPACT-MI Trial - CSL112 (Apolipoprotein A-I) Infusions and Cardiovascular Outcomes in Patients (..)

Aortic valve

Aortic valve Myocardial Infarction Aortic Blood Pressure

Burden of Coronary Artery Disease as a Predictor of New Vascular Events and Mortality in Patients With Ischemic Stroke: Insights From the Norwegian Stroke in the Young Study

Journal of the American Heart Association

MARCH 13, 2025

In the subsample of patients without clinical CAD but with femoral plaque on ultrasound (n=58) who underwent cardiac computed tomography, 46% (n=27) had nonobstructive CAD and 28% (n=16) had obstructive CAD. During a median followup of 10.1 ConclusionsIn young and middleaged ischemic stroke survivors, a quarter of patients had CAD.

Coronary Artery Disease

Coronary Artery Disease Stroke Strokes Ultrasound

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

Bedside ultrasound with no apparent wall motion abnormalities, no pericardial effusion, no right heart strain. A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Am Heart J. 2000;139:430–436. Am J Cardiol.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

How Does Exercise Prevent Heart Disease?

All About Cardiovascular System and Disorders

APRIL 30, 2024

Plaque regression can be demonstrated by ultrasound evaluation of the carotids which are easily accessible. Maintaining normal blood pressure also reduces the risk of stroke and myocardial infarction. Regular exercise can bring down the blood pressure in the long run.

Exercise

Exercise Heart Disease Blood Pressure Cholesterol

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

Dr. Smith's ECG Blog

MAY 20, 2024

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). Smith comment : Is the ACS (rupture plaque) with occlusion that is now reperfusing? Murakami MM.

Chest Pain

Chest Pain Blood Pressure Ischemia STEMI

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

JANUARY 5, 2024

So there is probability of myocardial injury here (and because it is in the correct clinical setting, then myocardial infarction.) Although it is statistically unlikely, multiple plaque ruptures are possible. The PDA plaque was also bulky, but was not described as inflamed or ulcerated. Heitner et al.

Angina

Angina Plaque Document Stents

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. An angiogram is a "lumenogram;" most plaque is EXTRALUMINAL!!

Plaque

Plaque Chest Pain Thrombosis Stenosis

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

If the arrest was caused by acute MI due to plaque rupture, then the diagnosis is MINOCA. MINOCA: Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease). Here is my comment on MINOCA: "Non-obstructive coronary disease" does not necessarily imply "no plaque rupture with thrombus." What is Type 2 MI?

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

Is this a STEMI? No, not by definition! Why not? Why is this Important?

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This was diagnosed by IVUS (intravascular ultrasound) as a ruptured plaque. Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. As there was ruptured plaque, this is NOT Prinzmetal's angina.

STEMI

STEMI Angina Myocardial Infarction Plaque

MINOCA : When a heart attack is not a heart attack

Dr. Sanjay Gupta

DECEMBER 19, 2022

The term MINOCA stands for Myocardial infarction with non-obstructive coronary arteries. She had some very minor plaque but certainly nothing that could explain the heart attack and therefore she was discharged with a diagnosis of MINOCA i.e I’ll try and explain this a bit better by using a case study.

Heart Attack

Heart Attack Heart attacks Blood Clot Chest Pain

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Here is the abstract: Background Identification of ST elevation myocardial infarction (STEMI) is critical because early reperfusion can save myocardium and increase survival.

Ischemia

Ischemia STEMI Stenosis Chest Pain

A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Here’s the angiogram of the RCA : No thrombus or plaque rupture in the RCA (or any coronary artery) was found. This MI wasn’t caused by a ruptured plaque of CAD - it was a coronary artery dissection of the RCA. Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis.

Chest Pain

Chest Pain SCAD STEMI Cardiogenic Shock

ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

Dr. Smith's ECG Blog

JANUARY 4, 2021

Both of these patterns together suggest Aslanger's pattern , recently published in J Electrocardiology: A new electrocardiographic pattern indicating inferior myocardial infarction. Case Continued Bedside ultrasound was performed: This shows an anterior wall motion abnormality, and highly suggests the LAD as the infarct artery.

Ischemia

Ischemia Pulmonary STEMI Chest Pain

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). He was taken to the cath lab and underwent emergent intervention: Thrombotic stenosis of the proximal RCA (95% with evidence of plaque rupture) is the culprit for the patient's inferoposterior STEMI.

Bradycardia

Bradycardia Cardiogenic Shock STEMI Ischemia

Which patient needs a CT scan?

Dr. Smith's ECG Blog

DECEMBER 16, 2024

This was ruptured plaque with thrombus. And almost all of them could be detected by bedside ultrasound. Conclusion: you may take a few moments to look for dissection with your bedside ultrasound, but when it is a clear STEMI, do NOT waste time with a CT scan. Ultrasound Med. Case 2 A 50-something y.o. Dissection is rare.

Chest Pain

Chest Pain STEMI Aortic Ultrasound

Normal ACS care, everything by the book! But normal ACS care could be much better. This post explains everything.

Dr. Smith's ECG Blog

MARCH 17, 2025

Nevertheless, the operator performed intravascular ultrasound and saw erupted calcium nodule consistent with plaque erosion. showed that use of intravascular imaging (intravascular ultrasound [IVUS] or optical coherence tomography [OCT]) reduces all cause mortality by 25% compared to angiography guided intervention.

STEMI

STEMI Chest Pain Myocardial Infarction Document

Cardiovascular Update

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Exosomal circSCMH1/miR-874 ratio in serum to predict carotid and coronary plaque stability

Tissue characterisation and primary percutaneous coronary intervention guidance using intravascular ultrasound: rationale and design of the SPECTRUM study

Webinars

Imaging patients with myocardial infarction with non-obstructive coronary arteries (MINOCA)

Intravascular Imaging Can Improve Outcomes for Complex Stenting Procedures

Abstract 4140066: In ACS patients within 4 hours of pain to balloon time, the impact of no-reflow after PCI and ultrasound attenuation as detected by intravascular ultrasound on the incidence of no-reflow.

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

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

Burden of Coronary Artery Disease as a Predictor of New Vascular Events and Mortality in Patients With Ischemic Stroke: Insights From the Norwegian Stroke in the Young Study

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

How Does Exercise Prevent Heart Disease?

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

Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Is this a STEMI? No, not by definition! Why not? Why is this Important?

MINOCA : When a heart attack is not a heart attack

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

A young peripartum woman with Chest Pain

ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Which patient needs a CT scan?

Normal ACS care, everything by the book! But normal ACS care could be much better. This post explains everything.

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