Dr. Smith's ECG Blog

JUNE 17, 2024

He was started on a heparin drip and CTA of the chest was ordered to rule out pulmonary embolism. This is a case like many others posted (see list below) and the EKG from the patient’s original presentation can be quickly recognized as diagnostic for pulmonary embolism. Now another, with ultrasound. In fact, Kosuge et al.

Chest Pain 139

Chest Pain Embolism Pulmonary Tachycardia 139

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

In patients with narrow QRS ( not this patient), this pattern is highly suggestive of acute pulmonary embolism. Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. In PE, there is almost always some hypoxia without any pulmonary edema. So CT is required to find the diagnosis!

Cardiogenic Shock 128

Cardiogenic Shock Ultrasound Tachycardia Pulmonary 128

Frontiers in Cardiovascular Medicine

JULY 1, 2024

Notably, acute massive pulmonary embolism (PE) with bilateral atrial thrombosis is an exceptional occurrence in CAPS. Acute pulmonary embolism (PE) is a common cardiovascular disease that progresses rapidly and has a high mortality rate. It primarily affects small vessels, seldom impacting large vessels.

Thrombosis 52

Thrombosis Embolism Pulmonary Laboratory 52

ECG Cases

NOVEMBER 6, 2018

This Best Case Ever elucidates the practical challenges of working up pregnant patients in the ED with a suspicion of pulmonary embolism. Since this recording, the first ever multi-center prospective outcome study looking at the pulmonary embolism workup in pregnancy was published in the Annals of Internal Medicine.

Embolism 52

Embolism Pulmonary Outcomes Ultrasound 52

Circulation: Heart Failure

FEBRUARY 1, 2024

n=42; median RAP, 4 mm Hg; pulmonary capillary wedge pressure, 11 mm Hg), those with a low JV distensibility ratio (≤1.6; BACKGROUND:Clinical evaluation of central venous pressure is difficult, depends on experience, and is often inaccurate in patients with chronic advanced heart failure. versus 18.2%; log-rankP=0.034).CONCLUSIONS:Ultrasound-assessed

Heart Failure 40

Heart Failure Ultrasound Heart Transplant Pulmonary 40

Circulation

NOVEMBER 11, 2024

He was requiring supplemental oxygen and an initial bedside cardiac ultrasound was unremarkable. Despite his large clot burden, there was absence of obstructive shock.Transthoracic Echocardiogram and bilateral duplex venous ultrasound were obtained to evaluate for right heart strain and clot burden. Cardiology was consulted.

Embolism 40

Embolism Pulmonary Ultrasound ICU 40

Frontiers in Cardiovascular Medicine

OCTOBER 10, 2024

Genetic protein S (PS) deficiency caused by PROS1 gene mutation is an important risk factor for hereditary thrombophilia.Case introductionIn this case, we report a 28-year-old male patient who developed a severe pulmonary embolism during his visit. Ultrasound showed no thrombosis in the veins of both lower limbs.

Embolism 40

Embolism Pulmonary Chest Pain Thrombosis 40

Dr. Smith's ECG Blog

APRIL 12, 2013

He was in acute distress from pulmonary edema, with a BP of 180/110, pulse 110. He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema. The hypertension alone is the likely etiology of the pulmonary edema. He had no chest pain. The cath lab was activated.

STEMI 52

STEMI Pulmonary Stent Stents 52

Dr. Smith's ECG Blog

MARCH 26, 2024

We have seen this pattern in many pts with acute right heart strain on this blog. __ Smith : The combination of T-wave inversion in V1-V3 and in lead III is very specific for acute pulmonary embolism. Acute pulmonary embolism was confirmed on CT: The patient did well with treatment. Now another, with ultrasound. This is a quiz.

Chest Pain 69

Chest Pain Embolism Pulmonary Ischemia 69

Frontiers in Cardiovascular Medicine

MARCH 25, 2025

A venous Doppler ultrasound revealed an extensive right lower extremity DVT. Further imaging with a computed tomography (CT) pulmonary embolism (PE) protocol scan of the chest and abdomen identified IVC agenesis along with pulmonary emboli in the left central pulmonary arteries.

Pulmonary 52

Pulmonary Risk Factors Thrombosis Ultrasound 52

Dr. Smith's ECG Blog

APRIL 12, 2023

She had acute pulmonary edema on exam. On arrival, lung ultrasound confirmed pulmonary edema (B lines). A 49 year old woman with h/o COPD only presented with sudden dyspnea. There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.

Echocardiogram 52

Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease 52

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

European Journal of Heart Failure

JANUARY 10, 2025

Abstract Aims A cardiovascular magnetic resonance (CMR) approach to non-invasively estimate left ventricular (LV) filling pressure was recently developed and shown to correlate with invasively measured pulmonary capillary wedge pressure (PCWP). Mean CMR-PCWP decreased from baseline to 36weeks by 0.37 (95% confidence interval 0.78

Heart Failure 40

Heart Failure Pulmonary Ultrasound Diabetes 40

Frontiers in Cardiovascular Medicine

FEBRUARY 11, 2024

Purpose This study aims to evaluate deep learning (DL) denoising reconstructions for image quality improvement of Doppler ultrasound (DUS)-gated fetal cardiac MRI in congenital heart disease (CHD). Cine imaging was acquired using a balanced steady-state free precession (bSSFP) sequence with Doppler ultrasound gating. vs. 8.3 ± 3.6,

Congenital Heart Disease 64

Congenital Heart Disease Ultrasound Congenital Aortic 64

Journal of Cardiothoracic Surgery

JULY 7, 2024

Background Postoperative pulmonary complications (PPCs) after one-lung ventilation (OLV) significantly impact patient prognosis and quality of life. The lung ultrasound score (LUS) was assessed following anesthesia and resuscitation (T5). The occurrence of atelectasis was documented immediately after the surgery.

Pulmonary 40

Pulmonary Quality of Life Ultrasound Document 40

Conquering CHD

OCTOBER 1, 2024

Additionally, we had to go to a high risk OBGYN for an additional ultrasound to make sure Austin’s heart chambers developed properly (everything appeared OK at the time). It would be a lie to say that Austin didn’t have odds against him. During pregnancy, we learned I had velamentous cord insertion, requiring close monitoring.

Open-Heart Surgery 98

Open-Heart Surgery Ultrasound VSD Blood Pressure 98

Dr. Smith's ECG Blog

JANUARY 2, 2025

Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates. (And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status.

Tachycardia 116

Tachycardia Cardiomyopathy Blog Bradycardia 116

Dr. Smith's ECG Blog

DECEMBER 20, 2010

This case was posted on the [link] ultrasound site, of which this ECG blog is a part. I refer you to the video case presentation by one of my colleagues, Dr. Rob Reardon (who has, by the way, a fantastic collection of ED ultrasound cases). However, only the first ECG was shown, and it was recorded before the patient became ill.

Echocardiogram 52

Echocardiogram Cardiomyopathy Ultrasound STEMI 52

Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Bedside ultrasound showed volume depletion and no pulmonary edema. SVT with aberrancy?

Tachycardia 129

Tachycardia Atrial Fibrillation AFIB Atrial Flutter 129

The American Journal of Cardiology

DECEMBER 16, 2023

Publication date: Available online 15 December 2023 Source: The American Journal of Cardiology Author(s): Alberto Palazzuoli, Alessandra Cartocci, Filippo Pirrotta, Maria Cristina Tavera, Francesco Morrone, Francesca Vannuccini, Alessandro Campora, Gaetano Ruocco

Ultrasound 40

Ultrasound Heart Failure Pulmonary 40

Dr. Smith's ECG Blog

DECEMBER 15, 2015

A bedside cardiac ultrasound was recorded: Here is a still image of the echo: The red arrows outline the right ventricle and the yellow arrows outline the left ventricle chamber. It makes pulmonary embolism (PE) very likely. The small LV implies very low LV filling pressures, which implies low pulmonary venous pressure.

STEMI 40

STEMI Embolism Pulmonary Ultrasound 40

Frontiers in Cardiovascular Medicine

FEBRUARY 19, 2024

This comprehensive evaluation included the use of ultrasound echocardiograms, computed tomography (CT) scans, electrocardiograms, mutagenesis analysis, and structural analysis to gain insights into the patient's condition and the underlying mechanisms of PD. Further genetic testing identified a homozygous mutation c.2662G>T

Cardiogenic Shock 59

Cardiogenic Shock Quality of Life Heart Failure Laboratory 59

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think?

Aneurysm 124

Aneurysm Stent Stents Chest Pain 124

All About Cardiovascular System and Disorders

APRIL 14, 2024

Some of the other useful parameters are mitral E velocity deceleration time, changes in mitral inflow with Valsalva maneuver, mitral L velocity, isovolumic relaxation time, left atrial maximum volume index, pulmonary vein systolic/diastolic velocity ratio, color M-mode Vp and E/Vp ratio. J Cardiovasc Ultrasound. Ha J et al.

Bicuspid/Mitral 52

Bicuspid/Mitral Pulmonary Atrial Fibrillation Ultrasound 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CT angiogram showed extensive saddle pulmonary embolism. Now another, with ultrasound. On epinephrine and norepinephrine drips."

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

ECG Cases

MARCH 26, 2018

Rob always wished he had x-ray vision…but since he possesses no special powers…using Point-of-Care Ultrasound (POCUS) is the next closest thing. Robert Simard, an Emergency Physician at North York General Hospital and Sunnybrook Health Sciences Centre in Toronto.

Ultrasound 52

Ultrasound Hospital Embolism Pulmonary 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Smith comment: before reading anything else, this case screamed pulmonary embolism to me. I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

Cardiovascular Ultrasound

DECEMBER 1, 2024

Left atrium (LA) is far from simply being a passive connection chamber between left ventricle and the pulmonary circulation. In patients affected by mitral regurgitation (MR) an impairment in LA compliance and.

Bicuspid/Mitral 52

Bicuspid/Mitral Pulmonary Circulation Research 52

Cardiovascular Ultrasound

JANUARY 2, 2025

Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study the right ventricular (RV) function using RV pressure-strain loops. The assessment of these novel indexes of.

Pulmonary 52

Pulmonary Hypertension Research 52

Frontiers in Cardiovascular Medicine

MAY 8, 2024

The following scan revealed a rare vascular ring, which was identified as BDA extending from the confluent of the left pulmonary artery and right pulmonary artery, completely encircling the trachea to form an “O”-shaped vascular ring before finally converging into the descending aorta.

Congenital Heart Disease 40

Congenital Heart Disease Aortic Pulmonary Ultrasound 40

Dr. Smith's ECG Blog

APRIL 26, 2017

My opinion was that it was not a cath lab case, but I did suggest they do a bedside ultrasound to look for an anterior wall motion abnormality. The RV was small and IVC empty, making pulmonary embolism extremely unlikely. The RV was small and IVC empty, making pulmonary embolism extremely unlikely.

Chest Pain 52

Chest Pain STEMI Ultrasound Pulmonary 52

Dr. Smith's ECG Blog

JANUARY 4, 2021

Case Continued Bedside ultrasound was performed: This shows an anterior wall motion abnormality, and highly suggests the LAD as the infarct artery. The patient was slightly tachypneic and mildly hypoxic in the stabilization room and therefore the physicians obtained a CT pulmonary angiogram as well as aortogram to rule out dissection and PE.

Ischemia 40

Ischemia Pulmonary STEMI Chest Pain 40

ECG Cases

OCTOBER 18, 2021

In this month's EM Quick Hits podcast, Anand Swaminathan on tips and tricks in polytrauma, Rohit Mohindra on diagnosis and management of toxic megacolon, Jesse McLaren on ECG in pulmonary embolism, Victoria Myers on approach to the patch call for cardiac arrest, Brit Long on when to do a CT head before LP, Salim Rezaie on nebulized ketamine - the ketaBAN (..)

Cardiac Arrest 52

Cardiac Arrest Embolism Pulmonary Ultrasound 52

Dr. Smith's ECG Blog

APRIL 2, 2024

Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. The estimated pulmonary artery systolic pressure is 23 mmHg + RA pressure. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. Here is the initial ED ECG. What do you think?

Tachycardia 133

Tachycardia Pacemaker Cardiac Arrest Cardiomyopathy 133

DAIC

FEBRUARY 2, 2024

The updated workflow indicates that direct imaging guidance, such as ultrasound, may be used as an alternative to fluoroscopy. "As This is the most commonly used ablation catheter in the world for RF ablation and is fully integrated with the CARTO 3 System. 1 These included one pseudoaneurysm, one PV stenosis and one hematoma.1

Ablation 105

Ablation Atrial Fibrillation AFIB Heart Rhythm 105

Dr. Smith's ECG Blog

MAY 20, 2024

In SCAPE (sympathetic crashing acute pulmonary edema), Emergency providers seem now to regularly give high dose NTG, but when the BP is 170/105 in a patient who is not crashing, we often fail to give something to lower afterload. __ Here are some Images: The red circle shows the LAD coursing down the anterior interventricular sulcus.

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

Journal of Cardiovascular Electrophysiology

NOVEMBER 17, 2023

Abstract Introduction Esophageal injury is one of the most serious complications of pulmonary vein isolation (PVI) with thermic energy sources. Better tissue selectivity of primarily non-thermic pulsed field ablation (PFA) may eliminate collateral injury, particularly the risk of atrio-esophageal fistula (AEF).

Atrial Fibrillation 40

Atrial Fibrillation Ablation Ultrasound Pulmonary 40