Dr. Smith's ECG Blog

AUGUST 26, 2009

He called 911 and paramedics recorded a prehospital 12 lead ECG which showed a clear inferior STEMI (not shown, tracing could not be found). Published in Academic Emergency Medicine, vol. Objectives : To find the incidence of any rSTD or T-wave inversion (TWI) in angiographically proven inferior STEMI.

STEMI 52

STEMI Catheterization Laboratory Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Post Cath ECG: Obviously completing MI with LVA morphology, and STE that meets STEMI criteria (but pt is still diagnosed as "NSTEMI"). Day 12 ECG: FINAL DIAGNOSIS: "NSTEMI" Despite the fact that his day 4 ECG easily meets STEMI criteria, the patient is diagnosed as NSTEMI. Academic Emergency Medicine 27(S1): S220; May 2020.

STEMI 78

STEMI Myocardial Infarction Ischemia Academic 78

Dr. Smith's ECG Blog

MAY 30, 2023

There is an obvious inferior posterior STEMI(+) OMI. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. I say academically because the STD in V2 is diagnostic -- posterior leads are NOT necessary. What is the atrial activity? What to do?

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

APRIL 24, 2015

We found that 38% of out of hospital ventricular fibrillation was due to STEMI. Correlation of STEMI in Resuscitated Non-traumatic out-of-hospital Cardiopulmonary Arrest patients with Initial Rhythm and Cardiac Catheterization Findings (Abstract 580). Academic Emergency Medicine 17(s1):S194; May 2010 Reference : Scott NL.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Atrial Fibrillation Ischemia 52

Dr. S. Venkatesan MD

SEPTEMBER 1, 2024

It is a sad academic story ,most of the interventional cardiology community shrugged it off as a non-event. No one knows how the pPCI related delay was legally ratified and academically accepted by the elite cardiology forums. In LAD STEMI time is more crucial. In many countries, the hub-and-spoke model is struggling to deliver.

Thrombolysis 52

Thrombolysis Myocardial Infarction Academic STEMI 52

Circulation

FEBRUARY 26, 2024

The primary safety end point was Bleeding Academic Research Consortium 3 to 5 bleeding at 30 days.RESULTS:Between January 10, 2019, and September 18, 2021, a total of 2989 patients were randomized. The primary efficacy end point occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard ratio, 1.00 [95% CI, 0.63

Myocardial Infarction 40

Myocardial Infarction Academic Thrombosis STEMI 40

Dr. Smith's ECG Blog

JUNE 12, 2017

This is diagnostic of inferior MI, though does not meet millimeter criteria for "STEMI." He was worried for inferior MI and ordered another, which was recorded 15 minutes later: Now clearly and obviously diagnostic of inferior STEMI. Academic Emergency Medicine 24(1):120-124. It is not subtle any more. References : 1.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

MARCH 31, 2023

This was marked as "Not a STEMI" by the physicians. It is not a STEMI, but it is diagnostic of an LAD OMI (Occlusion MI). has outperformed many cardiologists in its ability to recognize with "high confidence" acute OMIs from ECGs not satisfying STEMI-criteria. This was sent to me by a friend.

Chest Pain 52

Chest Pain STEMI Blog Academic 52

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. Distinction of PMVT vs VFib is an academic one in this case ). The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The below ECG was recorded. Both PMVT and VFib occurred multiple times.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. S. Venkatesan MD

APRIL 13, 2024

They argue for either immediate intervention or defer transiently, postpone or just ignore , based on clinical ,hemodynamic * , Individual, institutional , or some other non academic factors. After all, globally 90% of all successful myocardial reperfusion is done by the humble streptokinase or the more glamorous TNK -TPA.

Thrombosis 52

Thrombosis Academic Thrombolysis Document 52

EMS 12-Lead

MARCH 19, 2023

It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. 2] Exotic ECG findings – in this case, PR-interval shortening – make for excellent academic inquiry, but should never be a point of distraction from pathognomonic occlusive coronary disease. Is this OMI?

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

Dr. S. Venkatesan MD

MARCH 16, 2024

Still , even today it is weird to see hours of academic time is consumed in CTO Interventions in any interventional cardiology meets. One more remote risk in CTO is, acute collateral shutdown causing STEMI/NSTEMI. Surprise… surprise !, There is some good news. What will happen if a single donor (RCA/LCX) gets closed?

Angina 52

Angina Exercise Interventional Cardiology Academic 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. Is that an obvious STEMI underneath that rhythm? Is this inferor STEMI? Atrial Flutter with Inferior STEMI? If I fix the rhythm will the ST changes resolve?

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

APRIL 22, 2019

Still does not meet STEMI criteria, but it is an obvious OMI And then another one became more obvious: Cath lab was activated and a 100% RCA occlusion was found. There is no ST elevation in inferior leads, but it may just be too early to manifest. Learning Points: 1. Beware ST depression in I and aVL.

Chest Pain 52

Chest Pain Arrhythmia Ischemia STEMI 52

EMS 12-Lead

APRIL 14, 2022

There is mixed overlap of ST-segment elevation (STE), ST-segment depression (STD), Hyperacute T waves (HATW), and deWinter pattern (which the ACC regards as a STEMI-equivalent but is better suited under the blanket of OMI). mg of SL NTG, along with a total of 100 mcg of Fentanyl with little to no change in symptoms.

ACE Inhibitor 52

ACE Inhibitor Physiology Chest Pain Academic 52

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). Academic Emergency Medicine 27(S1): S220; May 2020.

Chest Pain 83

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Code STEMI was activated. A man in his 80s with chest pain What, besides large anterior STEMI, is so ominous about this ECG? From an academic standpoint — I found several subtle ECG findings from the 2 tracings in this case to be especially interesting. This one of the highest risk OMI patterns possible to see on an ECG.

Chest Pain 52

Chest Pain Cardiogenic Shock Tachycardia Ischemia 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. Academic Emergency Medicine 27(S1): S220. Unfortunately, they follow their own guidelines only 6% of the time!! Lupu L, et al. Clin Cardiol 2022; [link] Labs included: hsTnI 156 ng/L, Hb 12 g/dL, WBC 12x10^9/L, Cr. mg/dL, K 3.5

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction ICU 52

Dr. Smith's ECG Blog

MARCH 14, 2025

He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. At the time of this initial ED ECG, his symptoms were improving ECG #1 on admission to the ED The patient was not seen quickly in the ED as it was a busy shift and the ECG did not meet STEMI criteria. The below ECG was recorded.

Chest Pain 106

Chest Pain Myocardial Infarction STEMI Ischemia 106

Dr. S. Venkatesan MD

FEBRUARY 3, 2025

It is a strange academic habit among cardiologists, that they have subdivided medical management into optimal and suboptimal. He is a STEMI patient (1 year old) with mild LV dysfunction and thinning of IVS and anterior wall. Academic lessons from this patient.

Stents 52

Stents Stent Academic Ischemia 52