Remove 2017 Remove Ischemia Remove Myocardial Infarction
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Update on Diagnosis and Management of Kawasaki Disease: A Scientific Statement From the American Heart Association

Circulation

This update summarizes relevant clinical data published since the 2017 American Heart Association scientific statement on KD related to diagnosis, cardiac imaging in acute KD treatment, and long-term management. Recent data have advanced the understanding of safety and dosing for several anti-inflammatory therapies in KD.

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An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

or basilar ischemia. 2017 Sep-Oct;50(5):561-569. Epub 2017 Apr 19. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization. EKG on arrival to the ED is shown below: What do you think? However, T waves do not appear to be hyperacute or hyperkalemic. J Electrocardiol.

STEMI 114
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Hypertrophic Cardiomyopathy

EMS 12-Lead

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.

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Occlusion/reperfusion through 6 ‘normal’ ECGs

Dr. Smith's ECG Blog

In the STEMI/NSTEMI dichotomy, NSTEMI is supposed to mean non-occlusive myocardial infarction, but this patient had transient Occlusion MI that was at risk for re-occlusion (like ‘transient STEMI’). Impact of total occluson of culprit artery in acute non-ST elevation myocardial infarction: a systemic review and meta-analysis.

STEMI 40
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Formula Utilization

EMS 12-Lead

Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction. It’s important to stress the presence of a normal QRS (i.e., References 1] Smith, S. Annals of Emergency Medicine, 60 (1), 45-56. 2] Driver, B.

STEMI 52
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A young peripartum woman with Chest Pain

Dr. Smith's ECG Blog

This strongly suggests reperfusing RCA ischemia. Troponins, echocardiogram An echocardiogram showed inferobasilar hypokinesis, further supporting a diagnosis of regional ischemia , likely of the area supplied by the RCA. There is also a Q-wave in III. There is also subtle STD in V3-V5. The initial troponin I was elevated at 0.75

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12 Example Cases of Use of 3- and 4-variable formulas, plus Simplified Formula, to differentiate normal STE from subtle LAD occlusion

Dr. Smith's ECG Blog

Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. J Electrocardiology 50(5):561-569; September/October 2017. This makes it almost certain that the ST elevation on the first one is due to ischemia. Annals of Emergency Medicine 2012;60:45-56.