2015 Ischemia STEMI 
Dr. Smith's ECG Blog
NOVEMBER 19, 2016
Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 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.
Dr. Smith's ECG Blog
AUGUST 3, 2017
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?
Dr. Smith's ECG Blog
MAY 8, 2023
Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). American Heart Journal 170(6):1255-1264; December 2015. Theiling BJ.
EMS 12-Lead
MAY 20, 2022
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 worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital.
Dr. Smith's ECG Blog
APRIL 22, 2022
The HEART and EDACS scores are helpful to risk stratify patients with chest pain, but they hinge on accurate ECG interpretation: a low score doesn’t apply if the ECG shows STEMI(+)OMI, and shouldn’t be used for STEMI(-)OMI or OMI reperfusion either 2. Lancet 2015 6. Learn the signs of reperfusion: as Dr. Am J Med 2021 5.
Dr. Smith's ECG Blog
FEBRUARY 23, 2023
Learning Points: Ectopic atrial rhythm can produce atrial repolarization findings that can be confused for acute ischemia, STEMI, or OMI. To the left of these tracings is schematic illustration of the Emery Phenomenon ( adapted from the 2015 post by Dr. Bojana Uzelac on Armel Carmona’s ECG Rhythms website ).
EMS 12-Lead
APRIL 2, 2022
Figure 1-1 My colleague, a faithful student of ECG interpretation, handed me the tracing and said that it warranted STEMI activation because of apparent terminal QRS distortion (TQRSD) in V2. ASA 324mg was administered while a STEMI activation was simultaneously transmitted to the nearest PCI center. Attached is the first ECG.
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