Dr. Smith's ECG Blog

APRIL 18, 2024

I sent this to the Queen of Hearts So the ECG is both STEMI negative and has no subtle diagnostic signs of occlusion. Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1]

STEMI 121

STEMI Chest Pain Myocardial Infarction Blog 121

The British Journal of Cardiology

NOVEMBER 29, 2023

Primary percutaneous coronary intervention (PPCI) remains the gold-standard treatment for ST-elevation myocardial infarction (STEMI). We present the case of a man in his 50s, admitted with cardiac arrest secondary to inferolateral STEMI.

STEMI 52

STEMI Cardiac Arrest Myocardial Infarction Ultrasound 52

Journal of the American Heart Association

FEBRUARY 19, 2025

BackgroundThere may be variability in willingness to perform percutaneous coronary intervention (PCI) in higherrisk patients who present with STsegmentelevation myocardial infarction (STEMI). There were 178 984 patients from 582 US hospitals presenting with STEMI who were included. versus 7.4%,P<0.001),

Myocardial Infarction 40

Myocardial Infarction Hospital STEMI Cardiac Arrest 40

Dr. Smith's ECG Blog

JULY 31, 2020

Their OMI Manifesto details how use of standard STEMI criteria results in an unacceptable level of inaccuracy, in which an estimated 25-30% of acute coronary occlusions are missed! The article by Aslanger, Smith et al that is featured above in today’s post has just been published.

STEMI 52

STEMI Article Chest Pain Blog 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

There’s inferior ST depression which is reciprocal to subtle lateral convex ST elevation, and the precordial T waves are subtly hyperacute – all concerning for STEMI(-)OMI of proximal LAD. There’s ST elevation I/aVL/V2 that meet STEMI criteria. This is obvious STEMI(+)OMI of proximal LAD. Non-STEMI or STEMI(-)OMI?

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Circulation: Cardiovascular Imaging

APRIL 3, 2025

BACKGROUND:Microvascular obstruction (MVO) is associated with heart failure (HF) following ST-segmentelevation myocardial infarction. Circulation: Cardiovascular Imaging, Ahead of Print.

Heart Failure 40

Heart Failure Myocardial Infarction STEMI Risk Factors 40

Circulation

NOVEMBER 11, 2024

Background:Little is known about the clinical relevance of interleukin (IL)-6 and the severity of patients with acute ST-elevation myocardial infarction (STEMI). Blood samples for biomarker analyses, including IL-6, were collected.Results:There were 64 consecutive STEMI patients. There was 75% of males.

STEMI 40

STEMI Myocardial Infarction Tricuspid Biomarkers 40

Coronary Artery Disease Journal

MAY 29, 2024

Background Despite advances in percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI), in-hospital mortality remains a concern, highlighting the need for the identification of additional risk factors such as serum iron levels. μmol/L) and a control group (Fe ≥7.8 μmol/L).

Myocardial Infarction 40

Myocardial Infarction Hospital STEMI Risk Factors 40

Circulation: Cardiovascular Imaging

MARCH 24, 2025

BACKGROUND:T2-weighted imaging is commonly used to measure myocardial salvage in reperfused myocardial infarction but is hindered by poor reproducibility and indistinct boundaries. The median MSI was 35.0% (interquartile range, 22.959.5%), with smaller MSI observed in patients with larger infarcts (P<0.001).

Myocardial Infarction 40

Myocardial Infarction STEMI Thrombolysis Cardiovascular Imaging 40

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

This is a value typical for a large subacute MI, n ormal value 48 hours after myocardial infarction is associated with Post-Infarction Regional Pericarditis ( PIRP ). Mechanical complications secondary to myocardial infarction are infrequent due to most patients receiving revascularization quite rapidly.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

AUGUST 3, 2023

OMI Pocket Guide The OMI Pocket Guide ( [link] ) is a user-friendly online resource designed to help healthcare professionals learn how to recognize subtle signs of acute coronary occlusion on the ECG which represent occlusion myocardial infarctions (OMI). I’ve accessed this hand OMI Pocket Guide on both my ipad and iphone.

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Blog Myocardial Infarction STEMI Hospital 92

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed when we extensively searched three electronic databases: PubMed, ScienceDirect, and Web of Science, for studies that compared conservative vs. invasive revascularization treatment outcomes for patients with SCAD from 2003 to 2023.

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SCAD Coronary Artery Bypass Graft Outcomes Myocardial Infarction 75

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

associated typical Myocardial Infarction therapies such as statins and ACE inhibitors with significantly decreased 1 year mortality in MINOCA patients, which suggests that they do indeed have a similar pathophysiology to MI patients with obstructive coronary disease. MINOCA I do not have the bandwidth here to write a review of MINOCA.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

DECEMBER 29, 2015

would require the ST/S ratio to be 25% for diagnosis of STEMI in LVH. The physician was concerned about STEMI, but also worried that she was overreacting, with the potential that LVH was producing a "STEMI-mimic." Can you diagnose an ACO (STEMI) when you also have LVH? The criteria of Armstrong et al. References 1.

STEMI 40

STEMI Myocardial Infarction Chest Pain Aneurysm 40

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. Thus, it has recently become generally accepted that most plaque ruptures resulting in myocardial infarction occur in plaques that narrow the lumen diameter by 40% of the arterial cross section may be involved by plaque.

Ischemia 122

Ischemia Plaque Stenosis Myocardial Infarction 122

Dr. Smith's ECG Blog

AUGUST 19, 2023

This is diagnostic of infero-posterior OMI, but it is falsely negative by STEMI criteria and with falsely negative posterior leads (though they do show mild ST elevation in V4R). They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. Circulation 2007 2. Khan et al.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). LAFB, atrial flutter, anterolateral STEMI(+) OMI.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. S. Venkatesan MD

NOVEMBER 25, 2023

” R outine nasal Oxygen has little use in the management of STEMI. Now,14 years later, some young researchers reaching out to this concept ,via liquid myocardial oxygen. was presented at the 2023 SCAI meeting in Phoenix. In fact, it can be harmful as it causes vasoconstriction. Circ Cardiovasc Interv.

STEMI 40

STEMI Myocardial Infarction Download Document 40

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Triage ECG (no prior for comparison): Computer algorithm read: "Sinus rhythm, low voltage QRS, inferior myocardial infarction, probably old." Post Cath ECG: Obviously completing MI with LVA morphology, and STE that meets STEMI criteria (but pt is still diagnosed as "NSTEMI"). He reported a normal stress test a few years ago.

STEMI 78

STEMI Myocardial Infarction Ischemia Academic 78

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Databases including Embase, PubMed, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and SINOMED were comprehensively searched for identifying studies published from 1977 to 19 May 2023. The models were mainly constructed using data from individuals diagnosed with ST-segment elevation myocardial infarction (STEMI).

Myocardial Infarction 59

Myocardial Infarction STEMI Article Diabetes 59

The American Journal of Cardiology

DECEMBER 13, 2023

Publication date: Available online 1 December 2023 Source: The American Journal of Cardiology Author(s): Craig R.

COVID-19 40

COVID-19 Myocardial Infarction STEMI 40

Dr. Smith's ECG Blog

JUNE 18, 2013

His ECG was repeated at this point: This shows a well developed anterior STEMI. To not see these findings is very common, and this patient would be given the diagnosis of NonSTEMI, with subsequent development of STEMI. It is not a missed STEMI, but it is a missed coronary occlusion. The peak troponin I was over 100.

STEMI 52

STEMI Chest Pain Myocardial Infarction Webinar 52

Dr. Smith's ECG Blog

MAY 23, 2023

Notice on the right side of the image how the algorithm correctly measures STE sufficient in V1 and V2 to meet STEMI criteria in a man older than age 40. As most would agree, this ECG shows highly specific findings of anterolateral OMI, even with STEMI criteria in this case. Thus, this is obvious STEMI(+) OMI until proven otherwise.

Chest Pain 98

Chest Pain STEMI Blog Stent 98

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Aslanger's pattern (Smith was co-author on this): A new electrocardiographic pattern indicating inferior myocardial infarction The next troponin returned at 8822 ng/L. 20% of cases that everyone would call a STEMI have a competely open artery by the time of angiogram 60-90 minutes later. Normal left ventricular wall thickness.

Chest Pain 119

Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

Circulation

NOVEMBER 11, 2024

Methods:STEMI patients who underwent coronary revascularization therapy and cardiac magnetic resonance (CMR) at about 4 days and 6 months between 2017 and 2023 were included. The patients were divided into groups (Group 1, FSF (-) during procedures with final TIMI-3; Group 2, FSF (+) with TIMI-3; Group 3, final angiogram was non-TIMI-3).

STEMI 40

STEMI Myocardial Infarction Kidney Disease Thrombolysis 40

Dr. Smith's ECG Blog

MARCH 9, 2023

Barely any STE, and thus not meeting STEMI criteria. Read our recent editorial: Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined. Read our recent editorial: Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

DECEMBER 29, 2023

But because there was no new ST elevation, the ECG was signed off as “STEMI negative” and the patient waited to be seen. This confirms these Q waves are caused by an acute infarct. But the ECG still doesn’t meet STEMI criteria. Am J Emerg Med 2023 2. Smith : Normal ST Elevation in V2-V4 never has an associated Q-wave!

Chest Pain 70

Chest Pain STEMI Myocardial Infarction Electrocardiogram 70

Dr. Smith's ECG Blog

SEPTEMBER 1, 2023

It was tested on a large database of known outcomes and was more than twice as senstivity as STEMI criteria and much better than cardiologists. Angiogram Culprit Lesion (s): ST elevation myocardial infarction due to 99% stenosis of the distal LAD Formal echo: Normal estimated left ventricular ejection fraction, 63%.

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Chest Pain STEMI Stenosis Myocardial Infarction 128

Dr. Smith's ECG Blog

JULY 14, 2023

So we activated the Cath Lab Angiogram: Impression and Recommendations: Culprit for the patient's anterior ST segment myocardial infarction and out of hospital V-fib cardiac arrest is a thrombotic occlusion of the mid LAD The first troponin returned barely elevated at 36 ng/L (URL = 35) In our study of initial troponin in STEMI, 26.8%

Cardiac Arrest 98

Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 98

Dr. Smith's ECG Blog

SEPTEMBER 24, 2023

A very large myocardial infarction. The next day the ECG not unexpectedly shows a completed transmural inferior and posterior wall infarction. The delayed activation of the cath lab would have been avoided had the treating physicians been trained in recognizing occlusion myocardial infarction.

Chest Pain 86

Chest Pain Atrial Fibrillation AFIB Myocardial Infarction 86

Dr. Smith's ECG Blog

MARCH 19, 2023

Angiogram: Culprit for the patient's inferior ECG changes and non-ST elevation myocardial infarction is a 100% acute thrombotic occlusion of the proximal RCA. The patient was diagnosed with a"Non-STEMI." Here is the main learning point: The infarct was due to an occluded artery (Occlusion MI, OMI).

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Document 52

Dr. Smith's ECG Blog

AUGUST 6, 2024

The ECG is diagnostic of occlusion myocardial infarction (OMI). It definitely does not fulfill STEMI criteria, and I would argue that it would not lead to cath lab activation in most centers. The overall read is OMI with HIGH confidence. == Below is the ECG of Patient #2 — as interpreted by the QOH.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The ECG was read as "No STEMI" and the patient was treated like an average chest pain patient (despite the fact that a chest pain patient with active pain and active subendocardial ischemia is very high risk). A New ST-segment elevation myocardial infarction equivalent pattern? Eur J Emerg Med. 2017;24:236–242. Am J Emerg Med.

Chest Pain 83

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

MARCH 27, 2023

I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI. Unusual and puzzling, as there was a large focal acute MI) Final Diagnosis: Acute MI, Non ST Elevation Myocardial Infarction.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

So there is probability of myocardial injury here (and because it is in the correct clinical setting, then myocardial infarction.) HsTnI drawn at that time was 9 ng/L (ref. 80%) and definitely too much for hour to hour. And, among our chief goals as medical providers — we want to treat pain when this can be safely done!

Angina 121

Angina Plaque Document Stent 121

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? Physician interpretation: "No STEMI." Physician: "No STEMI." Cardiologist interpretation: "Technically does not meet STEMI criteria but concerning for ischemia."

Chest Pain 52

Chest Pain STEMI Document Ischemia 52

Dr. Smith's ECG Blog

MAY 10, 2023

ng/mL This single initial troponin at this level, in the context of chest pain, is high enough to be diagnostic of acute myocardial infarction. Thus, Wellens' syndrome should be thought of as a transient OMI or transient STEMI. Transient STEMI is at high risk of re-occlusion. Her initial cTnI returned at 0.25

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52