Dr. S. Venkatesan MD

JUNE 26, 2024

Agarwal ,et al Radiographics 2017 ) Left main Atresia: Is it a sub-set of the anomalous origin of LCA from the right sinus ? We know, how adverse is the outcome of Left main STEMI. Right arising from the left sinus is much more commoner than left arising from the right. This topic of anomalous origin needs a separate discussion.

Coronary Angiogram 52

Coronary Angiogram Cardiothoracic Anatomy Atherosclerosis 52

Dr. Smith's ECG Blog

JUNE 12, 2017

This is diagnostic of inferior MI, though does not meet millimeter criteria for "STEMI." He was worried for inferior MI and ordered another, which was recorded 15 minutes later: Now clearly and obviously diagnostic of inferior STEMI. January 2017. There is also ST elevation in lateral precordial leads V5 and V6.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

DECEMBER 6, 2022

Had the cardiologists followed NSTEMI or transient STEMI guidelines, which recommend non-urgent cath, the patient could have redeveloped an OMI and had a worse outcome. But this foresight will not be recorded, because the patient was diagnosed as "transient STEMI", even though no ECG ever met STEMI criteria.

Chest Pain 52

Chest Pain STEMI Diabetes Circulation 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

Troponin T peaked at 2074 ng/L (very high, typical of OMI/STEMI). 21, 2017 ). Post PCI the patient became gravely hypotensive and "shocky". She stabilized on dobutamine and levosimendan infusions that could be discontinued after 24 hours. The LV EF was 57% at formal echo.

Pulmonary 104

Pulmonary Tricuspid Chest Pain Cardiogenic Shock 104

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ). The below ECG was recorded.

Arrhythmia 122

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 122

Dr. Smith's ECG Blog

JANUARY 1, 2024

As per Dr. Aslanger — a number of medical providers were initial confused by what initially appears as marked ST elevation with reciprocal ST depression, indicative of an acute STEMI. That was also my initial concern. No "baseline" ECG is available for comparison.

Tachycardia 105

Tachycardia Heart Failure Blog Ischemia 105

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

While this ECG is negative for “posterior STEMI”, the resolution of anterior ST depression (accompanied by the troponin elevation) confirms posterior OMI with spontaneous reperfusion. The second opportunity to make the diagnosis and expedite angiography was missed because the ECG never met STEMI criteria and continued to be labeled ‘normal.’

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

MAY 11, 2019

Computer interpretation: SINUS RHYTHM NON-DIAGNOSTIC ANTEROLATERAL ST ELEVATION BORDERLINE ECG The overreading cardiologist confirmed the computer interpretation (did not diagnose OMI or STEMI). Since the threshold for "STEMI" is 2.0 mm, this ECG actually meets STEMI criteria. Since the threshold for "STEMI" is 2.0

Chest Pain 52

Chest Pain STEMI Stents Stent 52

Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. So maybe she is better than I am.

Chest Pain 74

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 74

BoardVitals - Cardiovascular

JANUARY 18, 2021

ACS QID 75345 In 2017, the New England Journal of Medicine published the results of the Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation (RE-DUAL PCI) trial. Explanation: The EKG illustrates an inferior STEMI. Click here for a free trial. Sample Cardiology Board Review Practice Questions Question 1.

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. & Desai, M.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Bicarb 20, Lactate 4.2,

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

These kinds of cases were excluded from the study as obvious anterior STEMI. --QTc J Electrocardiology 50(5):561-569; September/October 2017. Case 1 Acute anterior STEMI from LAD occlusion, or Benign Early Repolarization (BER)? Case 4 Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04

Chest Pain 52

Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

European Heart Journal 38(41):3082-3089; November 1, 2017. And, in cases like the elderly patient with new-onset chest pain presented here — definitive diagnosis of acute STEMI is sometimes deceptively easy. BOTTOM LINE: Despite cardiac pacing — ECG #2 is diagnostic of a very large acute anterior STEMI.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

EMS 12-Lead

JUNE 20, 2022

A prehospital STEMI activation was transmitted to the closest PCI center, and 324mg ASA was administered. The attending crews were concerned for an ACS-equivalent of LAD occlusion and initiated a prehospital STEMI activation to the closest PCI center. As the conversation progressed, another ECG spontaneously printed. 2] Driver, B.

STEMI 52

STEMI Stents Stent Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) A recent study found that SCAD causes almost 20% of STEMI in young women. examined SCAD presenting as STEMI (unlike Hassan et al. A study by Hassan et al. Lobo et al. where more than 3/4 of cases were NSTEMI).

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

EMS 12-Lead

APRIL 14, 2022

There is mixed overlap of ST-segment elevation (STE), ST-segment depression (STD), Hyperacute T waves (HATW), and deWinter pattern (which the ACC regards as a STEMI-equivalent but is better suited under the blanket of OMI). 1] Vitals BP 160/110 HR 90 (trend) RR 24 (BBS CTA) SaO2 92% RA Attached is the Patient's ECG. link] [1] Zachary et al.

ACE Inhibitor 52

ACE Inhibitor Physiology Chest Pain Academic 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 She was having a transient STEMI, briefly. It did not progress to full STEMI with loss of the anterior wall, as in this case. Patients with transient occlusion may manifest only transient STEMI on ECG.

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STEMI Chest Pain Hospital Risk Factors 40

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

PCI mid LCx So this is an OMI (Occlusion Myocardial Infarction), but not a STEMI Echo: Decreased left ventricular systolic performance, mild/moderate. This figure comes from the Diamond T study (all type 1 MI were NSTEMI, not STEMI): Notice that the 6 hour value (far right) is very low for type 2 MI. Angiogram: LM 30% ostial.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

Dr. Smith's ECG Blog

DECEMBER 27, 2018

JACC 69(23):1694-1703; April 4, 2017. But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. S-wave is in V2 = 17 mm S-wave V4 = 9 mm Total = 26 (not greater than 28), so not LVH by the new rule! Nevertheless, it has the look of LVH. Peguero JG et al.

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

DECEMBER 13, 2019

normal variant, not pericarditis) A Young Man with Sharp Chest pain (normal variant, not pericarditis) 24 yo woman with chest pain: Is this STEMI? I’ve excerpted in Figure-1 , relevant paragraphs from a 2017 ESC ( European Society of Cardiology ) article on this subject by Xanthopoulos & Skoularigis ( ESC: Vol. 15-9/6/2017 ).

Pericarditis 52

Pericarditis Chest Pain Aortic Blog 52

Dr. Smith's ECG Blog

JANUARY 17, 2024

The limb leads have been removed because there was no ST elevation in those leads, the QRS complexes have been obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. But STEMI criteria ignore all this and look at ST segments in isolation.

Chest Pain 108

Chest Pain STEMI Myocardial Infarction Blog 108

Dr. Smith's ECG Blog

AUGUST 10, 2023

This doesn’t meet STEMI criteria so in the current paradigm there’s no urgency to getting an angiogram. The initial ECG suggested either subacute or reperfused inferoposterior occlusion and clearly does not meet traditional STEMI criteria. Discharge diagnosis was ‘STEMI’, even though no ECG ever met STEMI criteria.

Chest Pain 93

Chest Pain STEMI Ischemia Nursing 93

Dr. Smith's ECG Blog

DECEMBER 5, 2019

This is based on the Sieira et al, 2017, risk calculator , which gives a borderline risk score (2). Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. Syncope and ST Segment Elevation. And another finding.

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52