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 124

Ischemia Chest Pain Cardiac Arrest Blog 124

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.

Chest Pain 71

Chest Pain Pulmonary Embolism STEMI 71

Dr. Smith's ECG Blog

DECEMBER 13, 2023

link] == MY Comment , by K EN G RAUER, MD ( 12/11 /2023 ): == As per Dr. Smith — the KEY concept in today's case is proportionality. (THE PM CARDIO OMI AI APP) If you want this bot to help you make the early diagnosis of OMI and save your patient and his/her myocardium, you can sign up to get an early beta version of the bot here.

Blog 123

Blog Chest Pain Cardiac Arrest Cardiomyopathy 123

Ken Grauer, MD

OCTOBER 21, 2023

PEARL # 1: Although seeing an elevated Troponin would provide additional support for immediate cardiac catheterization — the clinical reality is that the initial Troponin reading will not always be elevated in patients with acute coronary occlusion ( See March 24, 2023 post in Dr. Smith's ECG Blog ).

Blog 99

Blog Chest Pain Ischemia STEMI 99

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 92

Chest Pain Heart Rhythm Sudden Cardiac Death Dysrhythmia 92

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.

Tachycardia 52

Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

OCTOBER 13, 2023

There is worrisome T-wave inversion in inferior leads as well, which is another clue to LAD Occlusion In fact, this ECG meets STEMI criteria!! Why does the conventional algorithm not diagnose STEMI? Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04

Chest Pain 116

Chest Pain STEMI Cardiac Arrest Myocardial Infarction 116

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. Hypercalcemia. The ioninzed calcium was 6.5 mEq/L (very high).

Chest Pain 52

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?

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Dr. Smith's ECG Blog

MARCH 23, 2025

Here is the PMcardio Queen of Hearts interpretation of the ECG: STEMI equivalent detected. Inferior and posterior OMI without STEMI criteria. About an hour later another ECG was obtained: Barely meets STEMI criteria in inferior leads, but obvious inferior and posterior OMI. The cath lab was now activated for STEMI.

STEMI 82

STEMI Chest Pain Myocardial Infarction Article 82

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

A 12-lead was recorded, showing "STEMI," but is unavailable. The patient was unconscious BEFORE the cardiac arrest, at the same time that she had strong pulses. Therefore, cardiac arrest is NOT the etiology of the coma. She was BVM ventilated and suctioned. Shortly thereafter, pulses were lost.

STEMI 89

STEMI Hemorrhage Cardiac Arrest Tachycardia 89

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. regardless of the ECG (when the repeat level came back).[1] References 1. Lindner et al. But the Serum K+ is " only " 6.2

Bradycardia 118

Bradycardia Cardiac Arrest Hypertension ICU 118

Dr. Smith's ECG Blog

JANUARY 13, 2025

Unexplained cardiac arrest or documented VF/polymorphic VT: +3 3. Unexplained sudden cardiac death (3 categories) (+0.5 - +2) 4. Cardiac arrest. Clinical History 2.a. of atrial fib/flutter at age less than 30: +0.5 syncope of unclear etiology: +1 2.c. Suspected arrhythmic syncope: +2 2.d. Family History 3.a.

Chest Pain 71

Chest Pain Cardiac Arrest Ischemia Sudden Cardiac Death 71