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Nature Reviews Cardiology, Published online: 23 April 2024; doi:10.1038/s41569-024-01035-9 Data from the DanGer Shock trial demonstrate that implantation of a microaxial flow pump in patients with ST-segment elevation myocardial infarction complicated by cardiogenicshock increases the survival rate compared with standard care alone.
The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated. Long term outcome is unavailable.
Here is the Queen of Hearts (version 1) interpretation: Click here to sign up for Queen of Hearts Access Angiogram images before and after intervention: Another view (before and after intervention): The patient was confirmed to be in cardiogenicshock, placed on ECMO, also with impella assist device.
The VSR is what is causing the cardiogenicshock! It has been estimated that in the aggregate, they occur at a rate of about 3 per 1000 patients with acute MI, and most of these events occur in patients with STEMI. PIRP is strongly associated with myocardial rupture. PIRP was associated with persistent upright T waves.
The conventional machine algorithm interpreted this ECG as STEMI. Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenicshock). See this post of RV MI with both McConnell sign and "D" sign: Inferior and Posterior STEMI. Both were wrong.
milla1cf Mon, 04/08/2024 - 18:07 April 8, 2024 — Implantation of the Impella CP micro-axial flow pump in the hours after a heart attack significantly increased the rate of survival at six months among people suffering cardiogenicshock, according to a study presented at the American College of Cardiology ’s Annual Scientific Session.
Older patients with STEMI-related cardiogenicshock have a greater risk of mortality and may not experience the same benefit from microaxial flow pump (mAFP) treatment as their younger counterparts, according to an exploratory secondary analysis of the DanGer Shock trial presented at AHA 2024 and simultaneously published in JACC.
Subtle as a STEMI." (i.e., A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenicshock. In our study, there were 20/53 complete LAD OMI (TIMI-0 flow) which did not meet STEMI criteria. None of the 20 ever evolved to STEMI criteria. This one is easy for the Queen. 1947;34:627–645.
The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. The patient in today’s case presented in cardiogenicshock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck.
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. The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. Vitals were normal except for oxygen saturation of 94%. Vitals were normal.
It may look identical t o the ST-T wave appearance seen after a STEMI with marked troponin elevation, that has now reperfused ( be this reperfusion spontaneous — or by treatment with PCI or thrombolytics ). A DDENDUM ( 10/26/2024 ) : I excerpted what follows below from My Comment in the August 12, 2022 post in Dr. Smith's ECG Blog ). =
== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). The patient died of cardiogenicshock: Go to the post to see the full explanation. How would you interpret this tracing?
Clinical presentation was stable angina 130/567 (22.9%), non-ST-elevation acute coronary syndrome (NSTEACS) 312/567 (55%), ST-elevation myocardial infarction (STEMI) 125/567 (22.0%), and STEMI with cardiogenicshock 13/125 (10.4%). The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,
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). The notes now refer to the patient being in cardiogenicshock, on pressors. It is already approved in Europe.
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