Dr. Smith's ECG Blog

JANUARY 31, 2020

So this is indeed diagnostic of myocardial infarction. Not immediately, at least, because this is NOT diagnostic of ACUTE (occlusion) myocardial infarction (Acute OMI). So I made an ED diagnosis of Non-Occlusion Myocardial Infarction (NOMI), and his next day angiogram confirmed NOMI.

Angina 52

Angina Stent Stents Aneurysm 52

The American Journal of Cardiology

MARCH 4, 2024

Publication date: Available online 4 March 2024 Source: The American Journal of Cardiology Author(s): Sanjit S. Jolly, Shun Fu Lee, Rajibul Mian, Sasko Kedev, Shahar Lavi, Raul Moreno, Gilles Montalescot, Ali Hillani, Timothy D. Henry, Valon Asani, Robert F. Storey, Johanne Silvain, James C.S.

Myocardial Infarction 40

Myocardial Infarction Stent Stents 40

Dr. Smith's ECG Blog

APRIL 14, 2024

So we know there is myocardial infarction and the patient has persistent pain, but it is very mild. The culprit was opened and stented. Only the ECG and presence or absence of pain can tell you what is happening right now. Again , I would give NTG and re-assess. Case continued: A 2nd troponin I returned at 744 ng/L.

Chest Pain 119

Chest Pain Ischemia Myocardial Infarction Ultrasound 119

Dr. Smith's ECG Blog

OCTOBER 8, 2024

She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Interpretation of acute myocardial infarction with persistent “hyperacute T waves” by cardiac magnetic resonance. 2023;82:194–202.

Cardiac Arrest 122

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock 122

Dr. Smith's ECG Blog

APRIL 22, 2024

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J. 2000;139:430–436. Am J Cardiol.

Chest Pain 117

Chest Pain Myocardial Infarction Anatomy Angina 117

Dr. Smith's ECG Blog

MARCH 31, 2024

Angiogram reportedly showed acute thrombotic occlusion of the first obtuse marginal which was stented. V5-V6) of any amplitude, is specific for Occlusion Myocardial Infarction (vs. Only when the first troponin (high sens trop I) returned at around 22,000 ng/L did the cardiologist reconsider. Peak troponin was not recorded.

Chest Pain 110

Chest Pain STEMI Ischemia Myocardial Infarction 110

Heart BMJ

AUGUST 14, 2024

Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.

Aneurysm 52

Aneurysm Chest Pain Myocardial Infarction Thrombosis 52

Frontiers in Cardiovascular Medicine

FEBRUARY 5, 2024

Anaphylaxis leads to plaque rupture or erosion leading to acute myocardial infarction (type II) and acute coronary stent thrombosis (type III). Here we share a case of Kounis syndrome type I caused by an allergy caused by a Cryptopteran bite.

Coronary Artery Disease 64

Coronary Artery Disease Electrocardiogram Myocardial Infarction Thrombosis 64

Stroke Journal

JANUARY 30, 2025

Background:Carotid artery stenting (CAS) and carotid endarterectomy (CEA) are two types of carotid revascularization procedures performed on symptomatic patients. Stroke, Volume 56, Issue Suppl_1 , Page ATP229-ATP229, February 1, 2025. This data provides further insight into the risks involved in carotid revascularization procedures.

Stent 40

Stent Stents Lipid disorders Heart Failure 40

The British Journal of Cardiology

NOVEMBER 10, 2023

The near-immediate or instant feedback learning process by which the heart responds to any new invasive procedural variation facilitates each new change; be it drug-eluting stent, drug-coated balloon, or both in different combinations and permutations.

Stent 40

Stent Stents Coronary Artery Disease Myocardial Infarction 40

CardiacWire

MARCH 2, 2024

The United States has been way behind other nations in using drug-coated balloons (DCB) to treat coronary in-stent restenosis (ISR), but that’s about to change thanks to the FDA approval of Boston Scientific’s AGENT Drug-Coated Balloon. vs. 24.0%) Target vessel myocardial infarction (6.4% vs 12.3%) Stent thrombosis (0.0%

Angioplasty 59

Angioplasty Stent Stents Myocardial Infarction 59

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Electrocardiographic Criteria to Differentiate Acute Anterior ST Elevation Myocardial Infarction from Left Ventricular Aneurysm. Former resident: "Just saw cath report, LAD stent was 100% acutely occluded." They of course opened and stented it. American Journal of Emergency Medicine 2005; 23(3):279-287.

Chest Pain 114

Chest Pain Aneurysm Stent Stents 114

The British Journal of Cardiology

NOVEMBER 29, 2023

Primary percutaneous coronary intervention (PPCI) remains the gold-standard treatment for ST-elevation myocardial infarction (STEMI). Additional arterial access via left brachial artery was obtained, and a covered stent was deployed successfully in the right femoral artery with satisfactory haemostasis.

STEMI 52

STEMI Cardiac Arrest Myocardial Infarction Ultrasound 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Just before 10 AM, the patient received a stent to the culprit OM. Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). Peak troponin was 12 ng/mL. & Griffin, J. link] Lee, T.

Chest Pain 130

Chest Pain Myocardial Infarction Blog Stent 130

Nature Reviews - Cardiology

APRIL 1, 2024

Nature Reviews Cardiology, Published online: 02 April 2024; doi:10.1038/s41569-024-01020-2 In ST-segment elevation myocardial infarction, the role of interventional modification of thrombi in the coronary arteries before stenting is controversial.

STEMI 40

STEMI Myocardial Infarction Embolism Stent 40

Stroke Journal

FEBRUARY 1, 2024

In this study, we evaluate the safety and efficacy of TCAR in patients with symptomatic internal carotid artery disease compared with carotid endarterectomy (CEA) and carotid artery stenting (CAS).METHODS:A The primary outcomes included a 30-day stroke or transient ischemic attack, myocardial infarction, and mortality.

Myocardial Infarction 40

Myocardial Infarction Stent Stents Stenosis 40

Dr. Smith's ECG Blog

OCTOBER 30, 2023

A 60 yo with 2 previous inferior (RCA) STEMIs, stented, called 911 for one hour of chest pain. The first hs troponin I returned at 1100 ng/L Angiogram Lesion on 1st Obtuse Marginal : Proximal subsection = 90% stenosis Stented. He had no h/o heart failure. DBT was 120 minutes, pretty good for a Non-STEMI OMI.

STEMI 123

STEMI Heart Failure Stent Stents 123

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The patient was transferred to CCU to consider surgical options. Clin Cardiol 2022 4. Herman, Meyers, Smith et al.

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

Dr. Smith's ECG Blog

MARCH 9, 2013

A stent was placed. In my experience, all Wellens' with significant myocardial infarction have evolution from type A waves to type B waves over 6-24 hours' time , so that the presence of type A or type B waves, I believe, are simply a matter of the timing of recording and the rapidity of evolution. de Zwaan C., Wellens H.J.J.,

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia Angina 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Aslanger's pattern (Smith was co-author on this): A new electrocardiographic pattern indicating inferior myocardial infarction The next troponin returned at 8822 ng/L. Previously placed stents in the LAD (multiple) and mid circumflex and patent Formal echocardiogram: Normal left ventricular size and wall thickness.

Chest Pain 118

Chest Pain Ischemia Echocardiogram Myocardial Infarction 118

Stroke: Vascular and Interventional Neurology

OCTOBER 2, 2023

BackgroundProcedural intravenous cangrelor has been proposed as an effective platelet inhibition strategy for stenting in acute ischemic stroke. Safety outcomes included rates of symptomatic intracranial hemorrhage, parenchymal hematoma type 2, petechial hemorrhage, and in‐stent thrombosis. 3.28];P=0.836). versus 0%;P=0.911).ConclusionCangrelor

Hemorrhage 40

Hemorrhage Thrombosis Stent Stents 40

Open Heart

JANUARY 19, 2023

Ischaemic events were defined as myocardial infarction, stroke, transient ischaemic attack or peripheral embolism at 1 year. Patterns of Non-adherence to Anti-Platelet Regimen in Stented Patients (PARIS) and Coronary Revascularisation Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) integer scoring systems were tested.

Aortic valve 52

Aortic valve TAVR Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

An open 90% LAD was stented. Here is the ECG the next AM: There was so little infarction that there are lateral, but no anterior reperfusion T-waves (normally, there would be Wellens' type waves after LAD reperfusion). Here is some older but very interesting literature on TIMI myocardial perfusion grade and ST resolution : 1.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. A New ST-segment elevation myocardial infarction equivalent pattern? An Impella was placed for cardiac output augmentation.

Chest Pain 82

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

Journal of Cardiovascular Pharmacology

OCTOBER 9, 2024

Patients in the combination AP +AC therapy group had a higher prevalence of CAD, myocardial infarction, and coronary/vascular stent placement compared to the AC monotherapy group. The median follow-up of patients was 57 months. The median follow-up of patients was 57 months.

Atrial Fibrillation 40

Atrial Fibrillation Myocardial Infarction Kidney Disease Stent 40

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.) On the combined basis of angiography and IVUS, this patient received stents to his mid RCA, proximal PDA, and OM. RCA and PDA before and after, arrows indicating stented regions.

Angina 120

Angina Plaque Document Stent 120

Dr. Smith's ECG Blog

AUGUST 6, 2024

The ECG is diagnostic of occlusion myocardial infarction (OMI). This led to immediate cath lab activation — which revealed total occlusion of a large 1st diagonal branch that was stented. == Below is the ECG of Patient #3 — recorded from a 35-year old man with sudden, new-onset CP. Patient #3 — turned out to have myocarditis.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

The British Journal of Cardiology

APRIL 16, 2024

Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intra-procedural complications. and the average number of stents 2.6. The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,

Outcomes 40

Outcomes Cardiogenic Shock Angina STEMI 40

Dr. Smith's ECG Blog

MAY 30, 2023

Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. Literature cited In inferior myocardial infarction, neither ST elevation in lead V1 nor ST depression in lead I are reliable findings for the diagnosis of right ventricular infarction Johanna E. Such an escape would have a wider complex.

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Stroke Journal

FEBRUARY 1, 2024

The primary outcomes included 30-day combined stroke and transient ischemic attack (TIA), myocardial infarction (MI), and mortality. This was explained in Figure 1.Results:A Results:A total of seven studies involving 24,246 patients were analyzed. 1.82), and MI (OR:1.29,95%CI:0.83-2.01) 2.01) but lower mortality (OR:0.42,95%CI:0.22-0.81).

Myocardial Infarction 40

Myocardial Infarction Stent Stents Stenosis 40

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. At that visit the patient was found to have an in-stent RCA occlusion. She's had multiple PCI procedures. Troponin I peaked at 18.323ng/L.

Chest Pain 111

Chest Pain Pacemaker Ischemia Stent 111

Dr. Smith's ECG Blog

MAY 20, 2024

Diagnosis of Type I vs. Type II Myocardial Infarction in Emergency Department patients with Ischemic Symptoms (abstract 102). This was a presumed culprit and a stent was placed. The only study I'm aware of that looked at this was mine, in which 4% of Type II MI had New ST Elevation. Murakami MM.

Chest Pain 125

Chest Pain Blood Pressure Ischemia STEMI 125

Dr. Smith's ECG Blog

JANUARY 1, 2013

The OM-1 was opened and stented, then the LAD was stented 3 days later. The acute infarct-related artery was off the circumflex and the affected wall was posterior (STEMI). The LAD had a 75% proximal lesion that by fractional flow reserve was hemodynamically significant. The posterior leads were falsely negative.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 52

Journal of Cardiovascular Pharmacology

NOVEMBER 6, 2023

Primary endpoint of systematic review and meta-analysis is the NACE (Net Adverse Cardiac Events) and secondary are MACE (Major Adverse Cardiac Events), mortality, bleedings, myocardial infarction and stent thrombosis. Subgroup analyses included studies using only ticagrelor-based regimens and three-months duration of DAPT.

Diabetes 40

Diabetes Myocardial Infarction Thrombosis Stent 40

Dr. Smith's ECG Blog

JULY 11, 2024

Case A 43 year old male with a history of DM II, hyperlipidemia, and a family history of myocardial infarction presented to a family clinic with two days of epigastric pain that started after consuming a meal. All three lesions had TIMI 2 flow prior to stenting. Because: 1) He has been reading this blog for a long time.

Outcomes 112

Outcomes Stenosis Outpatient Echocardiogram 112

Dr. Smith's ECG Blog

JUNE 17, 2017

Because of the high troponin, echocardiography was done and showed a wall motion abnormality in the anterior, anterolateral, and apical walls, consistent with LAD myocardial infarction. It was stented. Had it not opened on its own, it could have resulted in a very large anterior wall MI.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Stent 52

The British Journal of Cardiology

AUGUST 1, 2024

Elevated Lp(a) concentrations in patients with ischaemic heart disease have been linked to higher rates of peri-procedural myocardial infarction (MI) during percutaneous coronary intervention (PCI).

Peripheral Arterial Disease 40

Peripheral Arterial Disease Myocardial Infarction Plaque Cardiovascular Disease 40