2019, Cardiac Arrest and STEMI - Cardiovascular Update

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. COACT: The COACT trial was fatally flawed, and because of it, many cardiologists are convinced that if there are no STEMI criteria, the patient does not need to go to the cath lab. These studies did not address OMI ECG findings!!!

Defibrillator

Defibrillator Cardiac Arrest STEMI Chest Pain

ECG Blog #415 — The Cath showed NO Occlusion!

Ken Grauer, MD

FEBRUARY 3, 2024

Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Figure-1: The initial ECG in today's case — obtained after successful resuscitation from cardiac arrest. ( No CP ( C hest P ain ).

Blog

Blog Cardiac Arrest STEMI Plaque

A man in his 50s with acute chest pain who is lucky to still be alive.

Dr. Smith's ECG Blog

JUNE 21, 2023

You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form This EMS ECG was transmitted to the nearby Emergency Department where it was remotely reviewed by a physician, who interpreted it as normal, or at least without any features of ischemia or STEMI.

Chest Pain

Chest Pain Cardiac Arrest STEMI Defibrillator

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0 Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

ECG Blog #434 — WHY Did this Patient Arrest?

Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. Prompt cath is therefore advised if the post-ROSC shows an acute STEMI. To Emphasize: The phenomenon of T-QRS-D is not needed in today's case to recognize the acute STEMI.

Blog

Blog STEMI Cardiac Arrest Tachycardia

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information: A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed.

STEMI

STEMI Hospital Blog Defibrillator

Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Past medical history included RBBB without other cardiac history, but old ECG was not available. The prehospital and ED computer interpretation was inferior STEMI: There’s normal sinus rhythm, first degree AV block and RBBB, normal axis and normal voltages. Vitals were normal except for oxygen saturation of 94%. Vitals were normal.

Chest Pain

Chest Pain STEMI Pulmonary Embolism

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? Am J Med 2019, 132(5):622-630.

Ischemia

Ischemia STEMI Stenosis Chest Pain

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. Figure-2: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( See text ). == Addendum Note: Quinidine has a long history of use to treat cardiac arrhythmias and severe malaria.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation.

Ischemia

Ischemia Chest Pain Cardiac Arrest Blog

ECG Blog #400 — Is this a NSTEMI?

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). The January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

Blog

Blog Chest Pain Ischemia STEMI

ECG Blog #383 — Is this Coronary Disease?

Ken Grauer, MD

JUNE 6, 2023

But limitation of this ST elevation to a single lead is not consistent with any distribution of a STEMI. Unfortunately — the patient abruptly developed hypoxemia, followed by cardiac arrest with PEA. It was thought that this action precipitated the patient's desaturation, and led to his cardiac arrest.

Blog

Blog Pulmonary Hypertension Aortic

A Middle-Aged male with Chest Pain and an Unusual ECG

Dr. Smith's ECG Blog

MAY 6, 2019

If it is STEMI, it would have to be RBBB with STEMI. This ECG pattern may be diagnostic of B rugada S yndrome IF seen in association with: i ) a history of cardiac arrest; polymorphic VT; or of non-vagal syncope; and / or ii ) a positive family history of sudden death at an early age; and / or iii ) a similar ECG in relatives.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored. Then they did an MRI: Patient underwent cardiac MRI on 10/4 that showed mildly reduced BiV systolic function. This has resulted in an under-representation of STEMI MINOCA patients in the literature. From Gue at al.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Dr. Smith's ECG Blog

APRIL 15, 2019

A prehospital ECG was recorded (not shown and not seen by me) which was worrisome for STEMI. A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

Hyperthermia and ST Elevation

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

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI

Chest pain, among other symptoms. What do you see?

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

The computer called this Acute STEMI What do you think? STEMI never has a very short QT. There is Bazett, Fridericia, Hodges, Framingham and Rautaharju -- see here at mdcalc: [link] If the ST Elevation here were due to STEMI, it would be an LAD Occlusion. is: i ) SQTS ( S hort QT S yndrome ) ; and , ii ) Hypercalcemia.

Chest Pain

Chest Pain Cardiac Arrest STEMI Arrhythmia

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. Annals of Noninvasive Electrocardiology 2019. 8, 2019 ) — ( Jan. 30, 2019 ) — many others. We repeated the ECG: Brugada pattern is mostly resolved.

Sudden Cardiac Death

Sudden Cardiac Death Heart Rhythm Article Tachycardia

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

ECG Blog #415 — The Cath showed NO Occlusion!

A man in his 50s with acute chest pain who is lucky to still be alive.

Extreme shock and cardiac arrest in COVID patient

ECG Blog #434 — WHY Did this Patient Arrest?

Interventionalist at the Receiving Hospital: "No STEMI, no cath. I do not accept the transfer."

Two patients with chest pain and RBBB: do either have occlusion MI?

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

What are treatment options for this rhythm, when all else fails?

A man in his 60s with syncope and ST depression. What does the ECG mean?

ECG Blog #400 — Is this a NSTEMI?

ECG Blog #383 — Is this Coronary Disease?

A Middle-Aged male with Chest Pain and an Unusual ECG

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Hyperthermia and ST Elevation

Chest pain, among other symptoms. What do you see?

A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Diphenhydramine toxicity? Tricyclic?

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