Who Needs a CT Coronary Angiogram?
CT coronary angiograms are increasing in popularity as a non-invasive screening test for detecting blocks in coronary arteries.
Coronary arteries are blood vessels supplying oxygenated blood to the heart.
Angiograms are images of blood vessels, usually obtained by injecting medications for contrast from body structures.
CT angiograms are reconstructions from multi slice CT scans following injection of contrast material into a forearm veins.
Veins are blood vessels returning deoxygenated blood to the heart.
CT coronary angiogram can be done as an outpatient test, in the X-ray department.
As of now CT angiograms cannot repla...
Source: Cardiophile MD - April 18, 2024 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain
This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System.The patient presented to an outside hospitalAn 80yo female per triage “patient presents with chest pain, also hurts to breathe”PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB.HPI:
Abrupt onset of substernal chest pain associated with nausea/vomiting
30 min PTA. She reports associated SOB but no dizziness or LOC. She
was given NTG
at home before coming to the hospital. This was the ECG obtained at triage.This ECG was recorded and was reviewed remotely by a...
Source: Dr. Smith's ECG Blog - March 19, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Why is the angiogram normal?
Written byWilly FrickA man in his 50s with a 15 pack-year smoking history presented to his primary care physician ' s office complaining of intermittent headache. He also complained of intermittent mild chest pain radiating into into both shoulders and his back, as well as occasional unexplained sweating. (Although radiation into the left arm is most classic for coronary ischemia, radiation into both arms is actually modestly more predictive). The primary care physician ' s note indicates low suspicion for cardiac ischemia, but " for completion, check troponin and ECG. " If an ECG was obtained in the office,...
Source: Dr. Smith's ECG Blog - March 17, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
A man in his 40s with 3 days of stuttering chest pain
Written byWilly FrickA man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a workout. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It woke him the next day and radiated into his back. He was only able to sleep while sitting in a chair. He went to urgent care and had an ECG (not available) which was interpreted as normal, and was sent home. His pain returned, and he went back to the urgent care but was sent to the ER. His ECG is shown:What do you...
Source: Dr. Smith's ECG Blog - March 13, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
When the conventional algorithm diagnoses the ECG as COMPLETELY NORMAL, but there is in fact OMI, what does the Queen of Hearts PM Cardio AI app say? (with 10 case examples)
Conclusions Need Scrutiny.Proximal LAD Occlusion with STE in I and aVL, and hyperacute T-waves in V2-V6.Algorithm: Marquette 12 SL (GE)The Queen gets it rightCase 9 (prehospital and ED ECGs). Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. The ECG told the story. 30 yo woman with trapezius pain. HEART Pathway = 0. Computer " Normal " ECG. Reality: ECG is Diagnostic of LAD Occlusion.Prehospital ECG:There are hyperacute T-waves in V3-V5.The Queen gets it rightFirst ED ECG:Hyperacute T-waves persist. Called normal again! Algorithm: Veritas (on Mortara...
Source: Dr. Smith's ECG Blog - March 4, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
Next frontier in radiation free Cath lab : Fibro-optic guided Catheterization
It is a 120-year challenge. Can anyone replace Rontgen’s X-ray discovered in 1895 for medical imaging? The Nobel winning Invention redefined the way we looked at our body and management of diseases for over a century. However, the fact remained it is an invasive and injuring investigation. What is the alternative for the X-radiation ?
CT scan was a great invention, but it turned out to be a gigantic 360-degree clone of X-ray machine. Today’s cath lab, however sophisticated , is like spending hours together inside a hot Chernobyl coffee shop. MRI was a true game changer. With zero radiation, MRI came close i...
Source: Dr.S.Venkatesan MD - March 1, 2024 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized FORS cardiac catheterisation ice intra cardiac echocardiography ivus mri oct proton mri imaging radiation saftety ultrasound imaging Source Type: blogs
Fontan Fenestration: To do or not to do?
Leaving a fenestration in the interatrial septum during a Fontan repair is useful in relieving the central venous congestion when pulmonary blood flow is driven by venous pressure in Fontan repair. Data from a multicenter Pediatric Heart Network has been published in JACC: Advances [1]. Subjects were between 2-6 years at Fontan surgery done between 2010 and 2020 with cardiac catheterization done within 1 year prior to the surgery. Fenestration was done in 465 of the 702 patients. Interestingly placement of fenestration was associated with center and Fontan type – whether it was lateral tunnel or extra cardiac. Shorte...
Source: Cardiophile MD - February 24, 2024 Category: Cardiology Authors: Johnson Francis Tags: Cardiac Surgery General Cardiology Source Type: blogs
Acute dyspnea in an older woman, is it OMI?
Written by Willy FrickA woman in her 90s with a history of end stage renal disease and complete heart block status post dual chamber pacemaker presented from home with acute onset dyspnea. ECG is shown below.What do you think?The ST and T wave abnormalities jump off the page, but let ' s set that aside just for a moment to review the tracing systematically. The rate is 60 (and remember, slower heart rates are often seen in OMI). Close inspection revealsventricular pacing spikes, best seen in aVL. Many ECG readers will not comment any further on rhythm once ventricular pacing has been identified, but it...
Source: Dr. Smith's ECG Blog - February 18, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
Right Heart Catheterization in Tetralogy of Fallot
With the availability of high resolution echocardiographic images and Doppler echocardiography, role of cardiac catheterization has come down in tetralogy of Fallot and other congenital heart diseases in general. Important risks for cardiac catheterization in a deeply cyanotic infant are the chance of precipitation of a cyanotic spell and thrombotic strokes due to hemoconcentration. Chance of precipitating a cyanotic spell are more when pulmonary angiography is attempted through the already narrow right ventricular outflow tract. Hemocontration is due to the diuresis following contrast angiography, which can be prevented ...
Source: Cardiophile MD - January 15, 2024 Category: Cardiology Authors: Johnson Francis Tags: Angiography and Interventions Source Type: blogs
Three normal high sensitivity troponins over 4 hours with a " normal ECG "
Written byWilly FrickA 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of " chest burning. " The documentation does not describe any additional details of the history. The following ECG was obtained.ECG 1What do you think?The ECG shows sinus bradycardia but is otherwise normal. There is TWI in lead III, but this can be seen in normal ECGs. No labs were obtained. The patient was given a prescription for albuterol and a referral to cardiology.Smith comment:No patient over 25 years of age with unexplained chest burning should be discharged without a troponin rule out, no matt...
Source: Dr. Smith's ECG Blog - January 5, 2024 Category: Cardiology Authors: Willy Frick Source Type: blogs
50-year old with chest pain, “no ischemic changes”
Written by Jesse McLaren A previously healthy 50 year-old presented
with 24 hours of intermittent exertional chest pain, radiating to the arms and
associated with shortness of breath. It was ongoing on arrival in the emergency
department. Below is the old ECG (on top) and then new ECG (on bottom). What do
you think?There is normal sinus rhythm, normal
conduction, normal axis, and tall precordial voltages with J waves from early
repolarization. The old ECG has proportional ST elevation and T waves.But the
new ECG has new Q waves in aVL and V2 (the distribution of the first diagonal
artery) – and in the next context o...
Source: Dr. Smith's ECG Blog - December 30, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Acute OMI or " Benign " Early Repolarization?
Written by Willy FrickA man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. He described it as severe, sharp, and substernal with associated nausea, vomiting, chills, and diaphoresis. The following ECG was obtained. Note that the machine read is" normal sinus rhythm, normal ECG. " Cardiology over read the tracing and signed the interpretation without modification.ECG 1What do you think?The Queen of Hear...
Source: Dr. Smith's ECG Blog - December 27, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
Concerning EKG with a Non-obstructive angiogram. What happened?
CONCLUSION: Given resolution of severe CP in association with the above marked improvement of ST-T wave abnormalities in virtually all leads during the less than 1 hour between the recording of ECGs #1 and #2 — this strongly suggests reopening of a " culprit " vessel (whichever vessel this was) — regardless of the fact that " no obstructive lesion was seen " at the time the cardiac catheterization happened to be done.The more than doubling of Troponin (even though " normal limits " for Troponin were not surpassed) — is consistent with a brief OMI, with only...
Source: Dr. Smith's ECG Blog - December 19, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
An ECG with only «marginal» change
DISCUSSION: This case nicely illustrates how subtle OMI changes really can be. The Queen of Hearts AI model did not identify OMI in the initial ECG.Below is the QoH explainability for the limb leads of the ECG #2 (left part of the image) and limb leads of ECG #3 (right side of the image). The sets of six limb leads are put next to each other for comparison. I ' ve excluded the precordial leads as they didn ' t add much information in this case. You can look at each leads and compare the two ECGs. You then can appreciate the dynamic change and see what parts of the waveform the QoH identifies as ischemic findings....
Source: Dr. Smith's ECG Blog - December 15, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
Occlusion myocardial infarction is a clinical diagnosis
Written by Willy Frick (@Willyhfrick). Willy is a cardiology fellow with a keen interest in the ECG in OMI.A woman in her late 70s presented with left arm pain. The arm pain started the day prior when she was at the dentist ' s office for a root canal. Her systolic blood pressure at the dentist was over 200 mm Hg. She was given nitroglycerin which improved her blood pressure, and she completed the procedure. Her arm pain abated. The pain returned that evening and woke her from sleep. She eventually fell back asleep, and woke up feeling normal the next day (the day of presentation). After dinner the day of presentatio...
Source: Dr. Smith's ECG Blog - December 11, 2023 Category: Cardiology Authors: Willy Frick Source Type: blogs
