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 ).

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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.

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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.

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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.

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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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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?

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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 ).

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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?

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Dr. Smith's ECG Blog

NOVEMBER 28, 2018

Saddleback ST Elevation is almost never STEMI 2. An inverted P-wave in lead V2 implies lead misplacement too high Saddleback in STEMI: Here are the only 2 ECGs with V2 "saddleback" that I have ever seen which really represented an LAD Occlusion: Anatomy of a Missed LAD Occlusion (classified as a NonSTEMI) A Very Subtle LAD Occlusion.T-wave

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Open Heart

MAY 23, 2022

Background The clinical significance of peak troponin levels following ST-elevation myocardial infarction (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

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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.

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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.

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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.

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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.

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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.

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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.

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