Remove Aneurysm Remove Echocardiogram Remove Stents
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Pulmonary Edema, Hypertension, and ST Elevation 2 Days After Stenting for Inferior STEMI

Dr. Smith's ECG Blog

A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. So it would be wise to look at the pre-discharge ECG, which was available: There are Q-waves and ST elevation on this pre-discharge (post-stent) ECG. He had no chest pain.

STEMI 52
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Abnormal echocardiographic finding mimicking paracardiac cystic lesion

Heart BMJ

Previous medical interventions included a spectrum of procedures, including catheter-directed thrombectomy for popliteal artery aneurysms with thrombosis, vascular bypass grafting for cerebral-anterior communicating artery aneurysms and arch replacement and stent implantation for aortic dissecting aneurysms.

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Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. The EKG is diagnostic of acute inferior, posterior, and lateral OMI superimposed on “LV aneurysm” morphology. It was stented. He wrote most of it and I (Smith) edited.

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See how bad the outcome can be if you don't know OMI findings on the ECG, and don't use the Queen of Hearts

Dr. Smith's ECG Blog

An echocardiogram showed severely reduced global systolic function with an EF of 20-25% and an LV apical thrombus. All three lesions had TIMI 2 flow prior to stenting. This is an RAO cranial projection of the left coronary vessels after thrombectomy and stenting. The LV aneurysm morphology persists.

Outcomes 100
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QS-wave in V2: 2 cases, different paradigms lead to different treatment times (STEMI - NSTEMI vs. OMI - NOMI)

Dr. Smith's ECG Blog

hours after that first diagnostic ECG) : Mid-LAD culprit lesion, 99% stenosis, no pre-intervention TIMI flow available, but described as "severe subtotal lesion", which was stented with reported TIMI 3 flow resulting. Another lesion in the proximal LAD with 80% stenosis was stented as well. Culprit lesion was reduced to 0% and stented.

STEMI 52
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LVH with anterior ST Elevation. When is it anterior STEMI?

Dr. Smith's ECG Blog

No prior echocardiogram was available for comparison. All these factors, again, support an ECG diagnosis of LVH The patient was nonetheless taken for emergency angiography, and a 99% mid-LAD lesion was found and stented. Is LVH like left ventricular aneurysm? In spite of those worries, she activated the cath lab. Am J Emerg Med.

STEMI 40
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A young patient with diminishing pain with a subtle but diagnostic ECG.

Dr. Smith's ECG Blog

Compare to the anatomy after stenting: The lower of the 2 now easily seen branches is the circumflex, now with excellent flow. Next day echocardiogram showed inferolateral hypokinesia with an EF of %45-50. This is seen just millimeters beyond the tip of the catheter. The patient recovered well. His peak troponin was over 5000 ng/L.