Dr. Smith's ECG Blog

MARCH 9, 2023

Barely any STE, and thus not meeting STEMI criteria. Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. He was given 6mg IV morphine for ongoing pain.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 52

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.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

BoardVitals - Cardiovascular

JANUARY 18, 2021

Other trials that evaluated this subject were the WOEST trial (2013), Pioneer AF-PCI trial (2016), and ISAR-TRIPLE (2015). Explanation: The EKG illustrates an inferior STEMI. Explanation: The RE-DUAL PCI trial evaluated differences between triple therapy and dual therapy using antiplatelets/anticoagulant. Incorrect Answers: A and E.

Bicuspid/Mitral 52

Bicuspid/Mitral Atrial Fibrillation Chest Pain STEMI 52

EMS 12-Lead

MAY 20, 2022

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. Smith comment : V5 and V6 are excessively discordant!!!! Here are two examples of HATW’s in the setting of confirmed LVH. References Naidu, S.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

From My Comment in the November 15, 2023 post in Dr. Smith's ECG Blog: Clinical Points about MINOCA: Given the literature citing a 5-15% estimated incidence of MINOCA in patients initially diagosed as having a STEMI or "NSTEMI" — it is important to be aware of the more common entities associated with this entity ( See Figure-2 ).

Plaque 127

Plaque Angina Blog Stent 127

Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

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.

Chest Pain 52

Chest Pain STEMI Blog Myocardial Infarction 52

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.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

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. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. 2015 Oct; 66(4):355-362. Look at the aortic outflow tract. What do you see? Annals of Emergency Medicine.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

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.

Myocardial Infarction 52

Myocardial Infarction Stent Stents STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 18, 2022

Figure-2: Comparison between ST elevation in lead V3 due to a repolarization variant ( TOP from the 4/27/2019 post) vs acute OMI ( BOTTOM from the 9/20/2015 post) , which manifests T-QRS-D ( See text ). MORE PRACTICE = 4 examples ( 3 positive; 1 not for T-QRS-D ). What About the ECGs shown in Today's Case?

Ischemia 52

Ischemia Blog Chest Pain Laboratory 52

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 ).

Blog 52

Blog Bradycardia Ischemia Exercise 52

Dr. Smith's ECG Blog

MAY 19, 2022

Anterior STEMI? T-wave inversions and dynamic ST elevation Tachycardia, hyperthyroid, and ST elevation. What is it? 2 Cases of Resolved Chest Pain with Dynamic Terminal T-wave Inversion Is it Wellens' Syndrome? Activate the Cath Lab?

Chest Pain 52

Chest Pain Exercise Pacemaker Coronary Angiogram 52

Dr. Smith's ECG Blog

MAY 23, 2022

Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. Theres inferior STE which meets STEMI criteria, but this is in the context of tall R waves (18mm) and relatively small T waves, and the STD/TWI in aVL is concordant to the negative QRS. This was false positive STEMI with an ECG mimicking OMI.

Chest Pain 52

Chest Pain Pericarditis STEMI Arrhythmia 52

Dr. Smith's ECG Blog

MARCH 14, 2025

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.

Chest Pain 106

Chest Pain Myocardial Infarction STEMI Ischemia 106

Dr. Smith's ECG Blog

MARCH 3, 2025

Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. An EKG from a year prior was available for comparison: The ED physician noted Initial EKG here read by the computer as a STEMI, however, there is a very poor baseline and a lot of artifact. See reference and discussion below.

Tachycardia 74

Tachycardia Pulmonary Chest Pain Stenosis 74

Dr. Smith's ECG Blog

JANUARY 23, 2025

He has never been poisoned by the STEMI/NSTEMI paradigm because he has never been to medical school. The Queen of Hearts recognizes this as OMI ("STEMI/STEMI Equivalent"). He just graduated from college. He has no medical training, but he has read this blog for years. He is an ECG tech who hopes to go to medical school.

Chest Pain 116

Chest Pain Ischemia STEMI Blog 116