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Background:Myocardial infarction with nonobstructive coronary artery disease (MINOCA) is a special syndrome with clear evidence of myocardialischemia, but no clear stenosis of coronary artery imaging sign. Circulation, Volume 150, Issue Suppl_1 , Page A4143007-A4143007, November 12, 2024.
DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. The ECG cannot diagnose the etiology of ischemia; it only the presence of ischemia, from whatever etiology.
Computer read: "Non-specific ST abnormality, consider anterior subendocardial ischemia" There are very poor R-waves in V1-V4 suggesting old anterior MI. Firstly, subendocardial ischemia does not localize on 12-Lead ECG. But the real question at hand is: Are these precordial ST-depressions a result of subendocardial ischemia?
The pain will resolve and you will think the ischemia is gone when it is only hidden ! Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardialinfarction (from the Cadillac trial). & Griffin, J. link] Lee, T. Weisberg, M.,
Lancet 2015 6. ST-elevation myocardialinfarction after pharmacologic persantine stress test in a patient with Wellens’ syndrome. Single High-Sensitivity Cardiac Troponin I to Rule Out Acute MyocardialInfarction. Was this objective evidence of inducible ischemia accompanied by chest pain?
There is broad subendocardial ischemia as demonstrated by STE aVR with concomitant STD that almost appears appropriately maximal in Leads II and V5. There is LBBB-like morphology with persistent patterns of subendocardial ischemia. This is the initial ECG: The QRS is widened with a regular cadence, and there are no discernable P waves.
He was found diaphoretic and uncomfortable, and verbalizing a prior history of myocardialinfarction 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 myocardialinfarction but absent in early repolarization.
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. Comparison of the QRS Complex, ST-Segment, and T-Wave Among Patients with Left Bundle Branch Block with and without Acute MyocardialInfarction.
American Heart Journal 170(6):1255-1264; December 2015. Diagnosis of Acute MyocardialInfarction in the Presence of Left Bundle Branch Block using the ST Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. EKG shown here: LAFB with no clear signs of OMI or ischemia. Derivation in LBBB: --> Smith SW.
Evidence of acute ischemia (may be subtle) vii. to 1.64) for myocardialinfarction or death from coronary heart disease, and 1.06 (95 percent confidence interval, 0.77 Old myocardialinfarction, 6. ST segment and T wave abnormalities consistent with or possibly related to myocardialischemia.
ECG #3 is easily recognized as OMI and the AI model recommends immediate revascularization The patient in today's case received suboptimal care and suffered a substantial myocardialinfarction. This case highlights how T-waves are very important in the assessment of ischemia and dynamic changes in acute coronary syndrome.
Case A 76 year old man with chronic hypertension but no history of coronary disease or myocardialinfarction presented to the ED with chest pain at 2343. His triage EKG is shown below: There is left bundle branch block, so the EKG must be evaluated for ischemia by Smith-modified Sgarbossa criteria.
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