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). Emergency coronary angiography showed coronary spasm and moderate lumen stenosis in the middle segment of left anterior descending artery (LAD).

Coronary Artery Disease 64

Coronary Artery Disease Electrocardiogram Myocardial Infarction Thrombosis 64

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

The cardiologist called this 20% stenosis. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus. That plaque is at risk of thrombosing again. It is worthwhile remembering that the majority of plaques which rupture are non-obstructive before they ulcerate and thrombose.

Plaque 70

Plaque Stent Stents Chest Pain 70

Stroke: Vascular and Interventional Neurology

NOVEMBER 9, 2023

However, CTA head and neck 4 days later demonstrated 90 percent stenosis of the mid left V2 at the C3‐4 level and a 75‐90 percent stenosis of the left mid V2 segment at the C5‐6 level (hard and soft plaque in these areas). He also had moderate stenosis of the right V4 segment.

Stenosis 40

Stenosis Peripheral Arterial Disease Atherosclerosis Pacemaker 40

Dr. S. Venkatesan MD

FEBRUARY 25, 2024

It means either a percutaneous coronary intervention with a stent or CABG. You may be. But I am not.You need to undergo some re-vascularisation procedure. What do you mean by that Doctor ? Can I get my heart re-vascularised by drugs alone Doctor ? No we can’t. Hmmm , wait, we do have something called OMT/GDMT.

Plaque 59

Plaque Chest Pain Stent Stents 59

Dr. Smith's ECG Blog

APRIL 22, 2024

Angiography : --Culprit for the patient's unstable angina/Wellen syndrome is a ruptured plaque in the mid LAD. --As Here are other very interesting posts: Wellens' syndrome: to stent or not? Total coronary occlusion, if very brief, may have minimal infarction and yet be very dangerous.

Chest Pain 120

Chest Pain Myocardial Infarction Anatomy Angina 120

Dr. Smith's ECG Blog

JANUARY 5, 2024

The LAD has diffuse disease with a few areas of moderate stenosis but no flow-limiting lesions. Although it is statistically unlikely, multiple plaque ruptures are possible. The PDA plaque was also bulky, but was not described as inflamed or ulcerated. RCA and PDA before and after, arrows indicating stented regions.

Angina 109

Angina Plaque Document Stent 109

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?

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. The image on the left shows the LAD before intervention, and the red circled portion on the right indicates the stented region. It is not rare.

Plaque 122

Plaque Angina Blog Stent 122

Dr. Smith's ECG Blog

JULY 11, 2024

The scan did not find PE, but showed evidence of coronary plaque: There are areas of dense white in the LAD (red and blue circles) and in the first diagonal (green circle). The red arrow shows a roughly 80% stenosis of the proximal LAD. The blue arrow shows another stenosis of the LAD distal to the first diagonal branch of about 99%.

Outcomes 94

Outcomes Stenosis Outpatient Echocardiogram 94

Cardiology Update

APRIL 9, 2024

SMART 4 ( NCT04722250 ) studied patients with severe aortic stenosis and a small aortic annulus who underwent transcatheter aortic valve replacement (TAVR). The primary non-inferiority endpoint was MACCE (a composite of cardiac death, MI, ischaemic stroke, stent thrombosis, or target vessel revascularisation).

Angina 52

Angina Myocardial Infarction Aortic valve Coronary Artery Disease 52

Dr. Smith's ECG Blog

MARCH 28, 2017

She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. It was stented. Regional wall motion abnormality-distal septum and apex. Learning Points : 1. Always get serial ECGs when there is any doubt about what is going on.

STEMI 52

STEMI Risk Factors Bicuspid/Mitral Ultrasound 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

She was treated medically for NonSTEMI, pending next day cath, which showed ulcerated plaque and a 60% thrombotic stenosis in the LAD distal to the first diagonal. It was stented. Regional wall motion abnormality-distal septum and apex. Learning Points : 1. Always get serial ECGs when there is any doubt about what is going on.

STEMI 52

STEMI Chest Pain Hospital Risk Factors 52

Dr. Anish Koka

JULY 15, 2023

Heartflow is a California based company that claims to be able to identify heart vessels leading to a lack of blood to the heart muscle that need coronary stents to fix. To make matters even more complicated, plaque in younger patients may be non-calcified and invisible to CT-calcium scans. Does Brad need a Heartflow scan?

Plaque 52

Plaque Heart Disease Outcomes Heart Attack 52

Dr. Smith's ECG Blog

MAY 10, 2023

LAD plaque with 0-25 percent stenosis. The LAD has moderate 40% ostial-proximal LAD stenosis and severe 90% mid LAD stenosis involving first diagonal branch. --The INTERVENTION * Successful angioplasty and stenting (drug eluting) of the mid LAD * Successful angioplasty of the ostial 1st diagonal Learning points: 1.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

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. He was successfully stented.

Bradycardia 52

Bradycardia Cardiogenic Shock STEMI Ischemia 52