Dr. S. Venkatesan MD

JANUARY 14, 2024

Will evolve into STEMI by prothrombotic trigger of lytic agent ECG will get normalised with clinical stability in some Nothing happens. Majority of Wellens end up as NSTEMI, statistics tells us about 20% of them can be STEMI in incognito mode demanding lysis or emergency PCI. ECG will remain same. How to manage Wellen syndrome?

Anatomy 52

Anatomy Angina STEMI Thrombosis 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? aVR ST Segment Elevation: Acute STEMI or Not?

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Ken Grauer, MD

FEBRUARY 18, 2023

Looking at the location of ST elevation ( ie, in the inferior leads — and in V4,5,6 ) — and the location of ST depression ( ie, in leads I,aVL; V1,V2 ) — this ECG picture suggests an ongoing acute infero - postero - lateral STEMI. What is S hark F in M orphology ? Cardiopulmonary resuscitation was promptly started — but was unsuccessful.

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Blog AFIB Chest Pain STEMI 78

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

There’s mild inferior ST elevation in III that doesn’t meet STEMI criteria, but it’s associated with ST depression in aVL and V2 that makes it diagnostic of infero-posterior Occlusion MI (from either RCA or circumflex)– accompanied by inferior Q waves of unknown age. Are there any signs of occlusion or reperfusion?

Chest Pain 52

Chest Pain STEMI Ischemia Stenosis 52

The British Journal of Cardiology

APRIL 16, 2024

Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intra-procedural complications. Pre-procedural data included patients’ baseline characteristics (age, gender, clinical presentation and comorbidities).

Outcomes 40

Outcomes Cardiogenic Shock Angina STEMI 40

Ken Grauer, MD

MARCH 7, 2023

This qualifies as " dynamic " ST-T wave change — and in a patient with new chest pain, this is indication for prompt cath to define the anatomy and ensure reperfusion. ECG Blog #294 — How to tell IF the "culprit" artery has reperfused. ECG Blog #194 — AIVR as a sign that the "culprit" artery has reperfused.

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Blog Chest Pain STEMI Ischemia 78

Dr. Smith's ECG Blog

AUGUST 9, 2018

Here it is: The computer reads STEMI What do you think? More from the medic: "LifePak 15 interpretation was STEMI. My response: "I think it is very worrisome for STEMI." It meets STEMI criteria even for a male under age 40, with STE 2.84 No history, meds, or risk factors. Pattern looked to be BER. mm in V2 and 4.08

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STEMI Chest Pain RN Anatomy 52

Ken Grauer, MD

OCTOBER 21, 2023

It tells us there is an active, ongoing process — and that prompt cath with acute reperfusion is likely to be needed regardless of whether or not the millimeter-definition of a STEMI has been satisfied. A cknowledgment : My appreciation to 張三毛 = JJ ( from Taiwan ) for the case and this tracing. =

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Blog Chest Pain Ischemia STEMI 96

Dr. S. Venkatesan MD

JUNE 26, 2024

2017 ) Clinical implication of such coronary anomalies Apart from angiographic surprises, these anomalous coronary arteries may under-perfuse the ventricle and present as unexplained cardiomyopathy , until we realize the anatomical errors in coronary anatomy. We know, how adverse is the outcome of Left main STEMI. Annu Rev Physiol.

Coronary Angiogram 52

Coronary Angiogram Cardiothoracic Anatomy Atherosclerosis 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

He wrote in his note that "The EKG showed early repolarization in I, V2-V3 but no clear STEMI pattern." See far below for data on 24 troponin T in STEMI and NSTEMI, and correlation with infarct size. The anatomy and lead placement create very small voltage compared to the other main coronary distributions. EF was 55%.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

Dr. Smith's ECG Blog

FEBRUARY 14, 2020

Some patients will not progress (or not as quickly) to obvious STEMI, as in this case. P EARL — One of the best ways to hone your ECG interpretation skills — is by r etrospective r eview of s erial t racings on cases in which you know the anatomy. Sometimes serial ECGs minimizes the delay.

Chest Pain 52

Chest Pain STEMI Anatomy Risk Factors 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

90% stenosis of the proximal ramus intermedius, pre procedure TIMI II flow The ramus intermedius is a normal variant on coronary anatomy that arises between the LAD and LCX. Recall that air is a poor conductor of electricity and will, therefore, generate smaller amplitudes on posterior leads (hence why STEMI criteria requires only >0.5

Chest Pain 52

Chest Pain Blog Stenosis Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Here is his angiogram: This shot shows that the left circumflex (LCx) is occluded at the ostium (origin). This is seen just millimeters beyond the tip of the catheter. The patient recovered well.

Myocardial Infarction 40

Myocardial Infarction Chest Pain Blog Echocardiogram 40

Dr. Smith's ECG Blog

AUGUST 28, 2020

This can only be due to STEMI. Initial priorities in this patient were clearly to determine the anatomy — and reestablish coronary perfusion. However, cardiogenic shock usually takes some time to develop, so it is probably subacute." Then I was told that the troponin I returned at greater than 50,000 ng/L.

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2018

Saddleback ST Elevation is almost never STEMI 2. An inverted P-wave in lead V2 implies lead misplacement too high Saddleback in STEMI: Here are the only 2 ECGs with V2 "saddleback" that I have ever seen which really represented an LAD Occlusion: Anatomy of a Missed LAD Occlusion (classified as a NonSTEMI) A Very Subtle LAD Occlusion.T-wave

STEMI 52

STEMI Chest Pain Cardiac Arrest Anatomy 52

Dr. S. Venkatesan MD

OCTOBER 31, 2024

Time window s for intervention for thrombolysis in STEMI starts from onset of chest pain, but when it comes to primary PCI, a different time window takes the center stage pushing the former to the background. How can we have uniform std of 90-120 minutes D2B in all STEMI cases ? Why is this disparity?

STEMI 40

STEMI Chest Pain Anatomy Thrombolysis 40

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

There is a very small amount of STE in some of the anterior, lateral, and inferior leads which do NOT meet STEMI criteria. The case was reviewed by all parties, and it was stated correctly that the ECG does not meet the STEMI criteria. The STEMI vs. NSTEMI paradigm is not the best way to decide who needs emergent reperfusion therapy.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. The ECG easily meets STEMI criteria in all leads V2-V6, as well. 24 yo woman with chest pain: Is this STEMI? This is not "diffuse", this is simply anterior, lateral, and likely apical.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

MARCH 17, 2025

First in slow motion with a freeze frame with annotated vessel anatomy, then at normal speed. Limitations of registry data: This patient presented with STEMI (-) OMI and developed STEMI the following day. In the world of STEMI, we are incapable of recognizing the first ECG as a false negative. Angiogram is shown below.

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STEMI Chest Pain Myocardial Infarction Document 81

Dr. Smith's ECG Blog

MARCH 1, 2025

Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. 2/3 of STEMI have a peak 4th generation troponin I greater than 10.0 Comment: The first ECG is diagnostic of OMI that does not meet STEMI criteria. NSTEMI-OMI").

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Chest Pain STEMI Stents Stent 121

Dr. S. Venkatesan MD

JANUARY 22, 2025

The fear comes built in with the diagnosis often amplified by young felllows on call (& often times by senior consultants as well) It may appear real, from a clinical angle, but trust, when we deal with the whole gamut of so-called ACS (other than STEMI), there is indeed a benign face in many of them.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Anatomy Angina 52

Dr. Smith's ECG Blog

DECEMBER 3, 2024

The first EKG was concerning for a Wellen’s-like pattern of subtle reperfusion changes in the setting of stuttering anginal-equivalent symptoms, but none were diagnostic of STEMI or OMI. Later in the night, the patient became bradycardic and developed a Mobitz II pattern , but he remained asymptomatic and hemodynamically stable.

Catheterization Laboratory 110

Catheterization Laboratory STEMI Blog Ischemia 110

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Queen : she saw no OMI (no "STEMI Equivalent") either Continued : Now, she says she was walking to the bathroom when she experienced acute onset substernal chest pressure radiating into her neck and left arm. Her ECG afterward is shown below: ECG from five days prior Smith : this shows an old inferior MI with persistent ST elevation.

Chest Pain 66

Chest Pain Hospital Anatomy Aneurysm 66