Dr. Smith's ECG Blog

MARCH 19, 2025

STEMI criteria are only 43% sensitive for OMI. McLaren : The inferior T wave inversion suggests either reperfusion (if resolved symptoms) or subacute refractory ischemia and from the previous description of pain refractory to nitro it is likely the latter. Beware confusing the diagnosis of posterior STEMI by using posterior leads.

Chest Pain 115

Chest Pain STEMI Stents Stent 115

Dr. Smith's ECG Blog

MARCH 3, 2025

Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. An EKG from a year prior was available for comparison: The ED physician noted Initial EKG here read by the computer as a STEMI, however, there is a very poor baseline and a lot of artifact. See reference and discussion below.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Ken Grauer, MD

MARCH 8, 2025

PEARL # 3: Knowing there is an acute inferior STEMI I looked next to see if there is also acute posterior involvement ( which so often accompanies inferior MI ). But larger-than-expected Q waves in each of the inferior leads ( especially in lead III ) are probably the result of this patients ongoing acute inferior STEMI.

Blog 103

Blog STEMI Download Chest Pain 103

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Unfortunately, the ECG was interpreted as no significant change from prior , "no STEMI"!! 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. He was sent back to the waiting room, where he suffered a VF arrest.

Cardiac Arrest 85

Cardiac Arrest STEMI Blog Ischemia 85

Dr. Smith's ECG Blog

JANUARY 24, 2025

Severe ischemia can be present even when the chest pain is gone. Learning points: 40% of LAD OMI with TIMI-0 flow do NOT meet STEMI criteria (manuscript under consideration at Eur Ht. 20/53 did not meet STEMI criteria, but all showed OMI diagnosed by both Smith and the Queen of Hearts. The CLINICIAN is the historian.)

Chest Pain 123

Chest Pain STEMI Risk Factors Coronary Artery Disease 123

Dr. Smith's ECG Blog

JANUARY 21, 2025

Time 7 hours lead reversal There is limb lead reversal (QRS in I and aVL are now inverted), but nevertheless one can see that the ischemia appears to have resolved. Negative trops and negative angiogram does not rule out coronary ischemia or ACS. This is extremely elevated for a type 2 MI and totally consistent with STEMI.

Chest Pain 61

Chest Pain STEMI Tachycardia Myocardial Infarction 61

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

A 12-lead was recorded, showing "STEMI," but is unavailable. Moreover, if you know that catastrophic intracranial hemorrhage can result in an ECG that mimics STEMI, then you know that this patient probably has a severe intracranial hemorrhage. She was BVM ventilated and suctioned. Shortly thereafter, pulses were lost.

STEMI 88

STEMI Hemorrhage Cardiac Arrest Tachycardia 88

Dr. Smith's ECG Blog

JANUARY 23, 2025

He has never been poisoned by the STEMI/NSTEMI paradigm because he has never been to medical school. His triage EKG is shown below: There is left bundle branch block, so the EKG must be evaluated for ischemia by Smith-modified Sgarbossa criteria. There is evidence of transmural ischemia of the posterior wall as well. Lucky Hans.

Chest Pain 115

Chest Pain Ischemia STEMI Blog 115

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

50% of LAD STEMI have Q-waves by one hour. Smith : In limb leads, the ST vector is towards lead II (STE lead II STE lead III, which is more likely with pericarditis than with STEMI). There were no other causes of dyspnea apparent and thus we can assume that myocardial ischemia started 6 days prior. See Raitt et al.:

Chest Pain 88

Chest Pain Pericarditis Myocardial Infarction Dementia 88

Dr. Smith's ECG Blog

JANUARY 11, 2025

The ECG shows sinus tachycardia, RBBB+LAFB, and signs of anterolateral acute transmural ischemia (most likely due to acute coronary occlusion), with concordant STE in I and aVL, inappropriate STE in V4-6 (though limited a bit by motion, still definite). Near 100% mortality without rapid reperfusion."

Cardiogenic Shock 136

Cardiogenic Shock Chest Pain Tachycardia Cardiac Arrest 136

Dr. Smith's ECG Blog

JANUARY 13, 2025

How well does the computer interpretation perform? -- in this case, the computer diagnosed STEMI but the patient had Fever with Brugada -- A young F is hyperthermic, delirious, and dry: Fever-induced Brugada? Among potential conditions that may produce Brugada Phenocopy are infarction and ischemia. Ischemia or infarction.

Chest Pain 70

Chest Pain Cardiac Arrest Ischemia Sudden Cardiac Death 70

Dr. Smith's ECG Blog

MARCH 8, 2025

It is possible there is microvascular dysfunction producing residual transmural ischemia. But this is most common when there is prolonged ischemia, and this patient had the fastest reperfusion imaginable! There was indication of parasympathetic overdrive ( the acute inferior STEMI with profound bradycardia and junctional escape ).

Cardiomyopathy 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74