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. The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. 2009;95:1701–1706.

ACS 83

ACS Coronary ALS CAD 83

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. It can only be seen by IVUS.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

JUNE 18, 2013

I want all to know that, with the right mind preparation, and the use of the early repol/LAD occlusion formula, extremely subtle coronary occlusion can be detected prospectively, with no other information than the ECG. It is not a missed STEMI, but it is a missed coronary occlusion. Fesmire et al. Wang T, Zhang M, Fu Y, et al.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. In the largest study looking at this topic by Mizusawa et al., She has not had a heart catheterization or after this event so the presence or absence of CAD is still unknown.

E-9-1-1 91

E-9-1-1 CAD OR STEMI 91

Dr. Smith's ECG Blog

JANUARY 9, 2023

No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Acute coronary occlusion almost always occurs in patients who are well beyond their teenage years.

Coronary 52

Coronary STEMI Heart Attack OR 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. Conversely, Matetzky et al.

STEMI 52

STEMI ACS Coronary CAD 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

JUNE 12, 2017

He had a family history of early CAD and occasional drug and tobacco use. However, subtle coronary occlusion may be completely missed by the computer and called "normal." Mawri S, Michaels A, Gibbs J, et al. It is not yet available, but this is your way to get on the list. This one was not even so subtle!!! References : 1.

STEMI 52

STEMI CAD Coronary ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. This is a very common misread.

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

JUNE 2, 2023

Late Gadolinium enhancement: Multifocal scarring of the septum (including RV septum), basal anterior wall and transmural mid inferior region scarring - a non-CAD hyperenhacement pattern. There is mild-moderate tricuspid valve regurgitation. Overall CMR findings are consistent with arrhythmogenic cardiomyopathy. RVEF 100 ml/m2.

ED 95

ED OR ALS CAD 95

Dr. Smith's ECG Blog

DECEMBER 29, 2015

Case history A middle-aged woman with a history of HTN, but no prior CAD, presented to the ED with chest pain. The criteria of Armstrong et al. LVH can mimic an acute anterior coronary occlusion (ACO) on the ECG. One retrospective analysis by Armstrong et al. Armstrong EJ, Kulkarni AR, Bhave PD, et al. J Emerg Med.

STEMI 40

STEMI Coronary ALS CAD 40

Dr. Smith's ECG Blog

MARCH 6, 2019

She also had non-acute CAD of the left main (50%) and LCX (75%). Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al. Krucoff et al.) ) to disastrous consequences that may deteriorate before the patient can be rushed to the cath lab. They opened it. Initial troponin T was 0.46

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

JULY 11, 2019

He also had non-acute CAD of the RCA (50%) and LCX (50%). This is a h igher - p revalence H istory for acute coronary disease. CLICK HERE — for a brief article by Rowlands et al that explains these concepts in more detail. Cath images: Before intervention. Before intervention with arrows demonstrating the area of occlusion.

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This study from Herzog et al (from our own Hennepin County Medical Center) included patients from a national registry and compared 3049 patients on dialysis admitted and eventually found to have acute MI compared with 534,395 patients not on dialysis admitted with an eventual diagnosis of acute MI. Herzog et al.

CAD 52

CAD OR ED ALS 52

ECG & Echo Learning

JANUARY 18, 2023

This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e III A Primary percutaneous coronary intervention strategy Management Recommendation Level of evidence Primary PCI of the infarct related artery (IRA) is indicated.

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

APRIL 8, 2016

He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. A late middle-aged man presented with one hour of chest pain. Most recent echo showed EF of 60%.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Acute coronary syndrome in a pediatric patient? He did have a family history notable for early CAD. hematological disorder like sickle cell or antiphospholipid syndome, family history of CAD or hypercholesterolemia, prior history of vasculopathies such as Kawasaki Disease, MIS-C, prior cardiac surgery, etc.)

Coronary 121

Coronary CAD ACS ALS 121