Dr. Smith's ECG Blog

MAY 13, 2020

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. Nevertheless, the clinical situation made other etiologies unlikely. NTG drip started.

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Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. ECG#1 Assessing ischemia on an ECG with wide QRS complexes (AIVR, ventricular pacing, BBB, etc) can be challenging. What do you think?

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Dr. Smith's ECG Blog

APRIL 18, 2024

5] Back to the case The patient had serial ECGs over the next hour with no significant change: The first troponin came back at 1,400 ng/L (normal <26 in males and <16 in females), confirming MI – and the patient’s refractory ischemia indicated this was an Occlusion MI. Clin Cardiol 2022 4. Herman, Meyers, Smith et al.

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STEMI Chest Pain Myocardial Infarction Stent 121

EMS 12-Lead

MAY 20, 2022

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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Dr. Smith's ECG Blog

MAY 6, 2019

Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. I was taught that the tell-tale sign of ischemia vs an electrical abnormality was in the hx, i.e. chest pain for the ischemia and potential syncope for brugada. Ischemia/infarction. It helps a little bit.

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analys is.

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DAIC

JANUARY 23, 2024

3 Patients with ASCVD are at a higher risk for major adverse cardiovascular events (MACE) including heart attack or myocardial infarction (MI), stroke, and cardiovascular (CV) death.4 Published 2018 Feb 6. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. 4 In the U.S. 12 Colchicine, 0.5

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Dr. Smith's ECG Blog

JULY 31, 2018

This is diagnostic of myocardial infarction. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. It they are static, then they are not due to ischemia. This is better evidence for ischemia than any other data point.

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Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. This was clearly severe subepicardial ischemia causing ST Elevation, but it was not of a long enough duration to result in measurable infarct.

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Dr. Paddy Barrett

AUGUST 1, 2023

2 Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. 2018 Sep 6;379(10):924-933. 5 ISCHEMIA Research Group. 5 ISCHEMIA Research Group. Medicine (Baltimore). 2022 Sep 16;101(37):e30583. N Engl J Med. 3 ESC Scientific Document Group. Eur Heart J. 2020 Jan 14;41(3):407-477. Eur Heart J. N Engl J Med.

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Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). Acute myocardial infarction in patients with dialysis Patients on dialysis have a well studied history of underdiagnosis and undertreatment for acute myocardial infarction.

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EMS 12-Lead

JUNE 20, 2022

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., With deliberate practice, spot diagnosis of T-to-R ratio will come with time. References 1] Smith, S. Annals of Emergency Medicine, 60 (1), 45-56.

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Dr. Smith's ECG Blog

DECEMBER 19, 2018

This confirms that there were dynamic signs of ischemia on the initial ECG. ng/ml , a three-fold increase from troponin #2, also confirming acute myocardial infarction. The ST depression in aVL is also resolved. It was not normal! A third troponin I returned at 0.27

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Dr. Smith's ECG Blog

NOVEMBER 24, 2018

Here it is: Computer Interpretation: SINUS RHYTHM INFERIOR MYOCARDIAL INFARCTION, POSSIBLY ACUTE ST ELEVATION, CONSIDER ANTERIOR INJURY [MARKED ST ELEVATION W/O NORMALLY INFLECTED T WAVE IN V2-V5] ACUTE MI What do you think? This ECG was texted to me with no information: I answered: "Show me the whole 12-lead."

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Dr. Smith's ECG Blog

MARCH 27, 2023

--The STD in V2-V6 might be interpreted as subendocardial ischemia, but with the inferior STE, it is far more likely to represent posterior OMI. In subendocardial ischemia, cath lab is indicated if the pain persists in spite of medical therapy (aspirin, anticoagulant, IV nitro). At 100 minutes, the above ECG was recorded.

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Chest Pain Ischemia Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The pain will resolve and you will think the ischemia is gone when it is only hidden ! Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). & Griffin, J. link] Lee, T. Weisberg, M.,

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Dr. Smith's ECG Blog

DECEMBER 18, 2022

Although not striking, this is clearly a diagnostic ECG for infero"posterior" myocardial infarction due to coronary occlusion (OMI), most likely due to left circumflex (LCx) artery occlusion. mm STE even in the fourth universal definition of myocardial infarction. Considerations on the naming of myocardial infarctions.

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Dr. Smith's ECG Blog

MARCH 6, 2019

She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. So what will you do for this patient? They found an acute, total, thrombotic occlusion of the proximal LAD. They opened it. Patel et al.,

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STEMI Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

JULY 11, 2018

Comment by KEN GRAUER, MD ( 7/11/2018 ): = Insightful blog post by Dr. Smith regarding ECG criteria for recognizing acute RV involvement in patients with inferior STEMI. The “bottom line” conclusions of their case report were that transient J waves may on occasion be induced by an acute injury current from impending myocardial infarction.

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Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 122(8):1303-1309. To me, this makes the ECG nearly diagnostic of ischemia, though if it is LAD occlusion, there should be ST depression in III and aVL, so it is a bit confusing.

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EMS 12-Lead

APRIL 2, 2022

He was found diaphoretic and uncomfortable, and verbalizing a prior history of myocardial infarction and that, furthermore, the acute symptoms were identical to that which had been associated with RCA stent placement 4 years prior. Terminal QRS distortion is present in anterior myocardial infarction but absent in early repolarization.

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Dr. Smith's ECG Blog

OCTOBER 6, 2018

If the patient had been "lucky," his symptoms from the prior day might have been due to ischemia prolonged and intense enough to result in small troponin increase. Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads.

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EMS 12-Lead

APRIL 28, 2022

In most cases, rather, the culprit is gross ischemia due to myocardial infarction, cardiomyopathy, or advanced coronary artery disease. Unfortunately, today’s case is lacking any such diagnostics, thus I cannot say with certainty that the QT interval is, or is not, culpable in arrhythmogenesis. [1] 6] Goldberger, A.

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