Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. It helps a little bit.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

This ECG is diagnostic of diffuse subendocardial ischemia. Door to balloon time (DBT) was 96 minutes for 7 patients with ST elevation myocardial infarctions (STEMI) who had CT prior to PCI vs. 75 minutes for 11 patients who did not have CT, p=0.058. Conclusions: Head CT is common in NT-OHCA.

Cardiac Arrest 52

Cardiac Arrest STEMI Hemorrhage Hospital 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

In the STEMI/NSTEMI dichotomy, NSTEMI is supposed to mean non-occlusive myocardial infarction, but this patient had transient Occlusion MI that was at risk for re-occlusion (like ‘transient STEMI’). Arch Cardiovasc Dis 2013 Khan AR et al. JAHA 2022 Grosmaitre P et al. Eur Heart J 2017 Driver BE, Shroff GR, Smith SW.

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

DECEMBER 16, 2019

Chest pain with New LBBB: It helps to actually measure the ST/S ratio A Fascinating Demonstration of ST/S Ratio in LBBB and Resolving LAD Ischemia The cath lab was activated. This was formerly an indication for cath lab activation, but was abandoned in the 2013 guidelines because of poor specificity. is worrisome!

Chest Pain 52

Chest Pain Myocardial Infarction Stent Stents 52

Dr. Smith's ECG Blog

JUNE 1, 2022

Here is his ECG: There is no clear evidence of OMI or ischemia. This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ).

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Bradycardia 52

EMS 12-Lead

APRIL 2, 2022

He was found diaphoretic and uncomfortable, and verbalizing a prior history of myocardial infarction and that, furthermore, the acute symptoms were identical to that which had been associated with RCA stent placement 4 years prior. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization.

Myocardial Infarction 52

Myocardial Infarction Stent Stents STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

This suggests further severe ischemia. associated typical Myocardial Infarction therapies such as statins and ACE inhibitors with significantly decreased 1 year mortality in MINOCA patients, which suggests that they do indeed have a similar pathophysiology to MI patients with obstructive coronary disease. Downstream vasospasm?

Coronary Angiogram 112

Coronary Angiogram Plaque Thrombosis STEMI 112

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" That said, complete LM occlusion would be expected to have subepicardial ischemia (STE) in these myocardial territories: STE vector 1.

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

It could also, given a different clinical context be compatible with a subacute myocardial infarction complicated by post infarct regional pericarditis. Due to the atypical and vague symptoms, the myocardial infarct was not initially diagnosed. At presentation he had a history of dyspnea for 6 days.

Chest Pain 91

Chest Pain Pericarditis Myocardial Infarction Dementia 91