Dr. Smith's ECG Blog

OCTOBER 24, 2013

An emergency cardiac ultrasound could be very useful. The upright portion of the T-wave in aVF is very large compared to the QRS size. These findings mandate that the patient at least get serial ECGs. If these remain unchanged, then serial troponins.

Cardiac Arrest 52

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia 52

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. He was started on nitro gtt.

Ischemia 122

Ischemia Plaque Stenosis Myocardial Infarction 122

Frontiers in Cardiovascular Medicine

AUGUST 8, 2024

However, the patient's cardiac Doppler ultrasound indicated poor cardiac contractions, and extracorporeal membrane oxygenation (ECMO) was started immediately. We administered adrenaline for cardiac excitation, dopamine for maintained blood pressure, sodium bicarbonate to correct the acidosis, and multiple electric defibrillations.

Cardiac Arrest 52

Cardiac Arrest Myocardial Infarction Coronary Artery Bypass Graft Stenosis 52

Dr. Smith's ECG Blog

APRIL 14, 2024

But there are also new Q-waves, stronly suggesting new infarction. A bedside cardiac ultrasound performed by a true EM expert (Robert Reardon, who wrote the cardiac ultrasound chapter in Ma and Mateer) showed an inferior wall motion abnormality. Overall interpretation: this does not look like OMI to me.

Chest Pain 119

Chest Pain Ischemia Myocardial Infarction Ultrasound 119

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 103

Aortic valve Myocardial Infarction Aortic Blood Pressure 103

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

Ultrasound 40

Ultrasound Plaque Blood Pressure Myocardial Infarction 40

Dr. Smith's ECG Blog

JUNE 27, 2021

A bedside ultrasound was done, with dozens of clips, and was even done with Speckle Tracking. Angiogram: "ACS - Non ST Elevation Myocardial Infarction. This is a HUGE myocardial infarction. There was no cough or fever, the CXR looks like pulmonary edema, the ultrasound showed classic pulmonary edema B lines.

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

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.

Stent 40

Stent Stents Outcomes Coronary Angiogram 40

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. Methods 701 patients were divided into stable coronary artery disease (SCAD), ACS, and control groups.

Plaque 59

Plaque SCAD Coronary Artery Disease Myocardial Infarction 59

Cardiology Update

MAY 14, 2024

Intravascular imaging (IVI), such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), play a crucial role in assessing lesion characteristics and optimizing stent placement during percutaneous coronary intervention (PCI). vs 6.7%; HR: 0.77; 95% CI: 0.61-0.97;

Outcomes 52

Outcomes Myocardial Infarction Ultrasound Article 52

The British Journal of Cardiology

NOVEMBER 29, 2023

Primary percutaneous coronary intervention (PPCI) remains the gold-standard treatment for ST-elevation myocardial infarction (STEMI). Successful PPCI was performed via right femoral artery, with access gained under ultrasound guidance.

STEMI 52

STEMI Cardiac Arrest Myocardial Infarction Ultrasound 52

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 118

Chest Pain Myocardial Infarction Anatomy Angina 118

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. In patients without previous CAD, but femoral plaque on ultrasound, nearly a half had nonobstructive and onefourth had obstructive CAD.

Coronary Artery Disease 40

Coronary Artery Disease Strokes Stroke Ultrasound 40

Dr. Smith's ECG Blog

AUGUST 9, 2024

However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. AIVR is not always the result of significant pathology, but is classically associated with the reperfusion phase of acute myocardial infarction. Do not treat AIVR.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. Smith's ECG Blog

JULY 7, 2013

If detected early by ultrasound, the patient can be saved. Our own Dave Plummer of HCMC reported on survival of 2 of 6 patients with free wall myocardial rupture diagnosed by bedside ultrasound in the ED.(3) 3) Oliva et al. (3) J Am Coll Cardiol 1995;25(5):1084-8. Armstrong PW et al. Circulation 1993;88(3):896-904.

STEMI 52

STEMI Myocardial Infarction Pericarditis Ultrasound 52

Circulation: Cardiovascular Interventions

NOVEMBER 28, 2023

BACKGROUND:There are limited data regarding the safety of deferral of percutaneous coronary intervention based on intravascular ultrasound (IVUS) findings. In both IVUS and FFR groups, vessels were classified into deferred or revascularized vessels, and patients were classified as those with or without deferred lesions.

Outcomes 40

Outcomes Myocardial Infarction Ultrasound Stenosis 40

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 52

Exercise Heart Disease Blood Pressure Cholesterol 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. MINOCA I do not have the bandwidth here to write a review of MINOCA. Lindahl et al.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Coronary Artery Disease Journal

JUNE 2, 2024

A pulmonary ultrasound was performed on admission and was considered positive (PE+) when there were three or more B-lines in two quadrants or more of each hemithorax. Conclusion Lung ultrasound and a high NT-proBNP (3647 ng/L in our series) on admission are the best predictors of acute heart failure needing MV in the first 48 h of ACS.

Heart Failure 40

Heart Failure Pulmonary Ultrasound Myocardial Infarction 40

Dr. Smith's ECG Blog

JULY 18, 2014

If detected early by ultrasound, the patient can be saved. Our own Dave Plummer of HCMC reported on survival of 2 of 6 patients with STEMI who had free wall myocardial rupture diagnosed by presence of hemopericardium on bedside ultrasound in the ED.(3) 3) Oliva et al. (4) J Am Coll Cardiol 1995;25(5):1084-8. Armstrong PW et al.

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. Literature on Hypokalemia as a risk for ventricular fibrillation in acute myocardial infarction. Use of diuretics is strongly associated with hypokalemia and ventricular fibrillation in myocardial infarction.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. 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. RVMI explains part of the shock.

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

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). And angiographers tell me that it is sometimes difficult to say for certain based on angiogram alone, without intravascular ultrasound or, better yet, optical coherence tomography. Murakami MM.

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

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. Takotsubo is a sudden event, not one with crescendo angina. Learning Points: 1.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

MAY 19, 2020

MINOCA: Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease). The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. I believe the latter (type II STEMI) is most likely.

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

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.) HsTnI drawn at that time was 9 ng/L (ref. 80%) and definitely too much for hour to hour. From angiography, it is not clear what the culprit is. The ECG changes were inferior, posterior, and lateral.

Angina 121

Angina Plaque Document Stent 121

Dr. Smith's ECG Blog

JUNE 17, 2018

Smith, MD – Department of Emergency Medicine, Hennepin County Medical Center, Professor, University of Minnesota School of Medicine, Minneapolis, MN ABSTRACT: Background: Patients with type 1 myocardial infarction with normal left ventricular function that are hemodynamically stable do not usually manifest with sinus tachycardia.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. Myocardial Infarction Type 2 and Myocardial Injury. 3–8 Shi et al.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

All About Cardiovascular System and Disorders

APRIL 14, 2024

J Cardiovasc Ultrasound. J Cardiovasc Ultrasound. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications. Ha J et al. 2009 Sep;17(3):86-95. Park JH et al. 2011 Dec;19(4):169-73.

Bicuspid/Mitral 52

Bicuspid/Mitral Pulmonary Atrial Fibrillation Ultrasound 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

After rethinking the case, he remained concerned about ACS and subsequently performed a point-of-care ultrasound in order to evaluate for regional wall motion abnormality. In equivocal cases, point-of-care ultrasound may be the difference between taking the patient to the lab or not. Gray, A., & & Mills, N.

Chest Pain 52

Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 21, 2024

Troponin T peaked at 38,398 ng/L ( = a very large myocardial infarction, but not massive-- thanks to the pre-PCI spontaneous reperfusion, and rapid internvention!! ). Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the ED ECG on arrival: Less STE/STD Provider's Clinical Impression: "findings concerning for myocardial infarction, likely proximal LAD or Left main." This was a point of care ultrasound, not a bubble contrast echo. Cath lab activated Dual antiplatelet therapy and heparin given. NTG drip started. Pain better still.

Echocardiogram 52

Echocardiogram Ischemia Chest Pain Blog 52

Dr. Smith's ECG Blog

APRIL 20, 2018

Given her risk factors (HTN, HLD, ESRD from diabetes) I decided to obtain a broad cardiac workup for the patient: serial ECGs, labs, serial troponins, CXR and bedside cardiac ultrasound. Ultrasounds can be very helpful in guiding your diagnostic pathway: location of WMA on US led to obtaining posterior leads.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

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. First, the name (Myocardial Infarction or Not) is not important.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. Occlusion Myocardial Infarction (OMI) often does not present with diagnostic ST elevation, or even any STE, especially in dialysis patients.

Chest Pain 52

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia 52

Dr. Smith's ECG Blog

APRIL 25, 2023

No pericardial effusion on ultrasound." See our publication: ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis There is STE in inferior leads, high lateral leads, and V4-V6. He had another episode the day before after exerting himself. What do you think?

Chest Pain 52

Chest Pain Pericarditis Blog Cardiomyopathy 52

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 52

Ischemia STEMI Stenosis Chest Pain 52