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 (..)

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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

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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

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.

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Plaque SCAD Coronary Artery Disease Myocardial Infarction 59

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.

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Chest Pain Myocardial Infarction Angina Anatomy 117

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.

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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.

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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.

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Heart Failure Pulmonary Ultrasound Myocardial Infarction 40

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.

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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.

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Chest Pain Blood Pressure Ischemia STEMI 125

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.

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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.

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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.

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Angina Plaque Document Stents 120

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.

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Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

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.

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Echocardiogram Ischemia Chest Pain Blog 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.

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Bicuspid/Mitral Pulmonary Atrial Fibrillation Ultrasound 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.

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Chest Pain Ultrasound Risk Factors STEMI 40

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?

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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.

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

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Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Sanjay Gupta

DECEMBER 19, 2022

The term MINOCA stands for Myocardial infarction with non-obstructive coronary arteries. Then I think it is important that patient has an assessment of the function of the heart by means of an ultrasound to look for cardiomyopathies, Takotsubo etc. I’ll try and explain this a bit better by using a case study.

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Heart attacks Heart Attack Blood Clot Chest Pain 40

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 40

Ischemia Pulmonary STEMI Chest Pain 40

DAIC

JUNE 12, 2024

Image courtesy: Philips christine.book Wed, 06/12/2024 - 14:07 June 12, 2024 — Royal Philips has announced its next-generation AI-enabled cardiovascular ultrasound platform to help speed up cardiac ultrasound analysis with proven AI technology and reduce the burden on echocardiography labs.

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Ultrasound Cardio Oncology Technology Congenital Heart Disease 105

Dr. Smith's ECG Blog

JANUARY 6, 2023

Association between opioid analgesia and delays to cardiac catheterization of patients with occlusion Myocardial Infarctions. Academic Emergency Medicine 27(S1): S220. Abstract 556. 2-hour hsTn: 615 ng/L; bedside ED echo (without contrast) did not show a clear wall motion abnormality (WMA).

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Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

MARCH 6, 2023

Regional wall motion abnormality-inferolateral (this is the formal ultrasound location of a posterior wall motion abnormality). Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. Regional wall motion abnormality-anterolateral. 2022.08.750 Section 5.2.2,

Chest Pain 52

Chest Pain STEMI Stenosis Blog 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. Revascularization in Patients With Spontaneous Coronary Artery Dissection and ST-Segment Elevation Myocardial Infarction. Type 2 is more difficult to appreciate on angiography than type 1. References Lobo AS et al.

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Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Ischemic ST-Segment Depression Maximal in V1-V4 (Versus V5-V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia). J Am Heart Assoc. 2021 Dec 7;10(23):e022866. doi: 10.1161/JAHA.121.022866. 121.022866. Epub 2021 Nov 15.

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. This was missed by the physicians, even with a bedside speckle tracking ultrasound: no wall motion abnormality was seen. Annals of Emergency Medicine 2012;60:45-56. It is below the cutoff of 23.4,

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Chest Pain STEMI Bradycardia Stenosis 52

Circulation

FEBRUARY 12, 2024

The 2 coprimary outcomes were target lesion revascularization and myocardial infarction. The secondary outcomes included ischemia-driven target lesion revascularization, target vessel myocardial infarction, death, cardiac death, target vessel revascularization, stent thrombosis, and major adverse cardiac events.

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Ultrasound Myocardial Infarction Stents Stent 67

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.

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Ultrasound Myocardial Infarction Cardiovascular Imaging Plaque 52

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.

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Chest Pain Arrhythmia Myocardial Infarction STEMI 107

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

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.

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Stents Stent Outcomes Coronary Angiogram 40

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;

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Outcomes Myocardial Infarction Ultrasound Research 52

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.

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STEMI Myocardial Infarction Pericarditis Ultrasound 52