Dr. Smith's ECG Blog

JANUARY 10, 2020

It could also be due to pericarditis or myocarditis, but I always say that "you diagnose pericarditis at your peril." The clinical presentation is very suggestive of myo-pericarditis. But one should always remember that acute MI is a far more common pathology than myo- or pericarditis. Pericarditis?

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Dr. Smith's ECG Blog

JULY 19, 2019

This morphology can be cause by or associated with cocaine: A Patient with Cocaine Chest Pain and Prehospital Computer interpretation of STEMI This is OMI of the anterior, lateral, and inferior walls until proven otherwise. But it does not meet STEMI criteria and it was not initially recognized. The cath lab was now activated.

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Dr. Smith's ECG Blog

NOVEMBER 13, 2022

This is a bad ST vector orientation, because it causes widespread STE and one of the most important mistakes that needs to be avoided here is thinking of the diagnosis of pericarditis. Such an out-of-proportion STE is virtually never seen in pericarditis. 2019 Apr;21(5):253-258. Look at the STE in lead II, aVF. Anatol J Cardiol.

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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.

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Dr. Smith's ECG Blog

MAY 16, 2023

There is a reasonable chance of pericarditis in this case, or this could be a baseline." Here is the Queen of Heart's interpretation: The cath lab had been activated for concern of STEMI. Sadly, I did not receive enough information to adjudicate whether this patient has pericarditis or not. I immediately responded: "cool fake!

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Dr. Smith's ECG Blog

NOVEMBER 1, 2022

Discharge Diagnosis was STEMI (The STE did not meet "criteria," so "OMI" would be better, but "STEMI" is far better than what this could have been called: NonSTEMI) Quotes from a note written by a really fine and knowledgable physician: "12-lead EKG was obtained initial 1 at time zero. Initial troponin came back negative."

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Dr. Smith's ECG Blog

AUGUST 8, 2020

This ECG clearly meets STEMI criteria by the way, regardless of age or gender. Haven't you been taught that this favors pericarditis? Weren't you taught that concave morphology favors pericarditis? This is a high troponin (most STEMI are above 10 ng/mL for troponin I). There is no STE or STD in III an aVF.

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Dr. Smith's ECG Blog

AUGUST 6, 2024

These latter findings are typical of pericarditis, but pericarditis never has reciprocal ST depression. It definitely does not fulfill STEMI criteria, and I would argue that it would not lead to cath lab activation in most centers. Usually with pericarditis and myocarditis — hyperacute T waves (HATW) are not present.

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Dr. Smith's ECG Blog

MARCH 11, 2019

You do NOT see this in normal variant STE, nor in pericarditis. Here is the computer interpretation: (Veritas algorithm) This is what I said: "This is diagnostic of an acute inferior MI. There is upsloping ST elevation in III, with reciprocal ST depression in aVL.

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