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.

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Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. As I review in My Comment in the January 16, 2020 post of Dr. Smith's ECG Blog ( and have reproduced in Figure-2 below ) — the ECG of patients with acute LMCA occlusion may be varied. The below ECG was recorded.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

JANUARY 8, 2024

She was diagnosed with a Non-STEMI and kept overnight for a next day angiogram. Medics recorded the above ECG and called a STEMI alert. The patient went into arrest pre-hospital. Her symptoms at the time ECG #1 was obtained were CP and SOB — yet interpretation of this initial tracing prompted a STEMI alert.

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Chest Pain Pulmonary Embolism STEMI 71

Dr. Smith's ECG Blog

OCTOBER 11, 2020

The provider contacted cardiology to discuss the case, but cardiology "didn't think it was a STEMI, didn't think he needed emergent cath." About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. The whole paradigm is literally called "STEMI" vs. "NSTEMI."

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Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

MAY 19, 2020

This is a troponin I level that is almost exclusively seen in STEMI. I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. So this is either a case of MINOCA, or a case of Type II STEMI. If the arrest was caused by acute MI due to plaque rupture, then the diagnosis is MINOCA.

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Dr. Smith's ECG Blog

AUGUST 1, 2020

He has done a lot of great work on cardiac arrest, including as co-author of our study on esmolol in refractory cardiac arrest, and much more with Keith Lurie. This was sent by Guillaume Debaty, from the Grenoble Region of France. See his Google Scholar profile here. Several of these are present in this case.

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Chest Pain STEMI Cardiac Arrest Ischemia 52

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 August 22, 2020 post in Dr. Smith's ECG Blog — which illustrates another case of dynamic ST-T wave changes that resulted from a repolarization variant.

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Blog Chest Pain Ischemia STEMI 99

Dr. Smith's ECG Blog

MAY 5, 2022

Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". Hyperkalemia mimics STEMI and OMI in many distributions, but probably the most common is the Brugada morphology in V1-V2 which mimics anterior OMI for those who cannot recognize the Brugada pattern. HyperKalemia with Cardiac Arrest.

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Chest Pain Bradycardia Cardiac Arrest STEMI 52

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.

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Ken Grauer, MD

MAY 26, 2023

At some point ~1-2 hours after the initial ECG — the patient developed runs of VT, leading to cardiac arrest. This blog post reviews the basics for predicting the " C ulprit" A rtery — as well as the importance of the term, " O MI" ( = O cclusion-based MI ) as an improvement from the outdated STEMI paradigm.

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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.

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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.

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Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. Code STEMI was activated. Plus recommendations from a 5-member panel on cardiac arrest. A man in his 80s with chest pain What, besides large anterior STEMI, is so ominous about this ECG? Eur Heart J.

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Dr. Smith's ECG Blog

FEBRUARY 27, 2023

See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life. I've reproduced this figure from My Comment in the January 6, 2020 post of Dr. Smith's ECG Blog ).

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Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This is a case written by Dan Lee (One of our fantastic Hennepin Residents, class of 2020 ) edits by Smith A 60 something-year-old man with a history of ESRD, LVH and prior CABG presented after an episode of hypotension during his hemodialysis, run followed by a syncopal episode which caused his run to be terminated early.

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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,

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

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. Treatment is by ICD ( implantable cardioverter defibrillator ).

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). Take home : Not all STEs are STEMIs or OMIs. What do you think?

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Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Unfortunately, the ECG was interpreted as no significant change from prior , "no STEMI"!! He was sent back to the waiting room, where he suffered a VF arrest. Approximately 5 minutes after ROSC, this ECG was obtained (about 45 minutes after arrival): Obvious anterolateral OMI, and STEMI criteria positive for those who care or need it.

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Dr. Smith's ECG Blog

JANUARY 11, 2025

Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin. Plus recommendations from a 5-member panel on cardiac arrest. Plus recommendations from a 5-member panel on cardiac arrest. These are often VERY difficult to recognized. Protocols can be overridden by Physician Judgment.

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Dr. Smith's ECG Blog

FEBRUARY 10, 2025

2] Curiously, ACLS does not include consideration of calcium in its bradycardia algorithm, which could have prevented the arrest and which along with the epi produced ROSC. HyperKalemia with Cardiac Arrest. Eur J Emerg Med 2020. regardless of the ECG (when the repeat level came back).[1] References 1. Lindner et al.

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