Remove 2012 Remove Ischemia Remove Stent
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Do you need to be a trained health care professional to diagnose subtle OMI on the ECG?

Dr. Smith's ECG Blog

He interprets here: "This EKG is diagnostic of right bundle branch block and transmural ischemia of the anterior wall, most likely from an occlusion of the proximal LAD. There was a 100% proximal LAD occlusion that was opened and stented. By the summer of 2012, he could read an ECG for OMI better than any doctor I knew.

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Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

The patient was referred immediately for cath which revealed RCA occlusion that was stented. Remember, in diffuse subendocardial ischemia with widespread ST-depression there may b e ST-E in lead s aVR and V1. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There is ST depression in V1.

Ischemia 103
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Formula Utilization

EMS 12-Lead

He was rushed to the Cath Lab where an LAD culprit lesion was stented. Here is the LAD after stent placement. It’s important to stress the presence of a normal QRS (i.e., This first image shows turbulent flow through stenotic narrowing of the vessel. With deliberate practice, spot diagnosis of T-to-R ratio will come with time.

Stent 52
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A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

Annals of Emergency Medicine 2012; 60(12):766-776. So the patient was taken for emergent cath, showing: Culprit artery: LAD (100% stenosis, TIMI 0) requiring thrombectomy and stent. EKG shown here: LAFB with no clear signs of OMI or ischemia. Queen of Hearts interpretation: Now the cardiologist considered it "STEMI"!

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Acute OMI or "Benign" Early Repolarization?

Dr. Smith's ECG Blog

The pain will resolve and you will think the ischemia is gone when it is only hidden ! Just before 10 AM, the patient received a stent to the culprit OM. We know that today's patient has had prior inferior OMI with stenting of his proximal RCA ~3 years earlier. Peak troponin was 12 ng/mL. Tikkanen, J. Wellens, H., &