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Background The clinical significance of peak troponin levels following ST-elevation myocardialinfarction (STEMI) has not been definitively established. Methods A single-centre retrospective observational study was conducted of all patients with STEMI between January 2015 and December 2017. The mean age was 63.6±12
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.
The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! Posterior STEMI occurs in approximately 15-20% of acute MI, but the vast majority of the time it is seen in conjunction with inferior (Infero-Posterior) or lateral (Postero-Lateral) STEMI (1).
Barely any STE, and thus not meeting STEMI criteria. Read our recent editorial: Hyperacute T-waves Can Be a Useful Sign of Occlusion MyocardialInfarction if Appropriately Defined. Read our recent editorial: Hyperacute T-waves Can Be a Useful Sign of Occlusion MyocardialInfarction if Appropriately Defined.
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. Patel J, Alattar F, Koneru J, et al. Case Rep Emerg Med 2014 7.
This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. As it currently stands, an ST/S ratio >15% should raise awareness for new anterior STEMI. New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardialinfarction in the emergency department.
Dr. Smith illustrates how to measure these parameters with magnified views in his December 21, 2015 post. In the context of the abnormal ST elevation we see in leads III and aVF I interpreted this mirror-image J-point depression as a reciprocal change in this LBBB patient whose ECG is diagnostic of an acute inferior STEMI.
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.
The important point for our purposes is that they do no represent myocardialinfarction. Anterior STEMI? Dr. Smith note: I wouldn't necessarily consider this ENTIRELY "benign." It is benign compared to acute MI, but it may be that people with such troponin elevations are at higher risk for long term mortality. What is it?
Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. myocardialinfarction), arrhythmias, valvular pathology, shunts, or outflow obstructions.
He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. At the time of this initial ED ECG, his symptoms were improving ECG #1 on admission to the ED The patient was not seen quickly in the ED as it was a busy shift and the ECG did not meet STEMI criteria. The below ECG was recorded.
He has never been poisoned by the STEMI/NSTEMI paradigm because he has never been to medical school. 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. The Queen of Hearts recognizes this as OMI ("STEMI/STEMI Equivalent").
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