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There were many comments that it was too late for thrombolytics or that this signified an LV aneurysm, not acute MI. See my formula for differentiating anterior LV aneurysm (that is to say, persistent ST elevation after old MI) from acute anterior STEMI. Both support acute anterior STEMI. It is not chronic. 3.0 = 0.50
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. Is this acute STEMI? Is this an acute STEMI? -- Unlikely! He had no chest pain. Medications were aspirin, clopidogrel, metoprolol, and simvastatin.
Smith : Old inferior MI with persistent ST Elevation ("inferior aneurysm") has well-formed Q-waves. In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!). So this NSTEMI was likely a STEMI(-)OMI with delayed reperfusion. Deutch et al.
Thus, this is BOTH an anterior and inferior STEMI in the setting of RBBB. How old is this antero-inferior STEMI? Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Could it be acute (vs.
Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. Cath showed a 95% LAD with flow. This was recorded 2.5
Diagnosis: There are Q-waves, ST elevation, and hyperacute T-waves in V2 and V3, diagnostic of acute LAD occlusion (STEMI). Sometimes you will find an obvious STEMI. This may resolve over a couple weeks; if it does not, then he is at high risk of developing an LV aneurysm, or diastolic dysfunction of the anterior wall.
Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Also note that they allow ST depression c/w posterior MI to be a STEMI equivalent. What is the utility of a head CT in cardiac arrest?
We have found in our study comparing inferior STEMI (manuscript in preparation) to inferior early repol several distinguishing characteristics. A coronary aneurysm was found. And young women have worse outcomes than other groups with STEMI because of the tendency to say, "Nah, couldn't be!" ng/ml 3 hours later.
Barely any STE, and thus not meeting STEMI criteria. Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. He was given 6mg IV morphine for ongoing pain.
It may be difficult to read STEMI in the setting of RBBB. There is, however, a long QT also, with abnormal T-waves, but this is not STEMI. An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL."
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. Repeat CT angio chest (not CT coronary, unclear what protocol) showed possible LAD aneurysm and thrombus. Pericarditis?
Despite ongoing chest discomfort and an uptrending troponin, he never meets STEMI criteria. The full thickness infarction with LV aneurysm morphology places him at a higher risk for short and long term complications (e.g., Free wall rupture, VSD, Dresslers Syndrome, chronic CHF, anatomic LV aneurysm, LV thrombus, stroke, etc).
Not quite a STEMI, but same effect.) There is ST elevation in V2-V4 that does not quite meet "STEMI criteria." You might think it is "Old MI with persistent ST Elevation" (otherwise known as "LV aneurysm" morphology.") Is this a transient STEMI? When Q-waves have developed, it cannot be assumed to be a transient STEMI.
Full case details and outcomes are below. The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? Physician interpretation: "No STEMI." Physician: "No STEMI." Case 1: Case 2: Case 1: What do you think?
cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. Perhaps she will not develop an LV aneurysm. LV Thrombus , 1.5
Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. A CT was completed to rule out dissection, PE, or aneurysm, and this was unremarkable. Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. mg/dL, K 3.5
It is clearly not a STEMI and is therefore a Non-STEMI or NSTEMI.) This shows that the term Non-STEMI is useless, as Non-STEMI can be either OMI or NOMI. What is needed is to feed the AI algorithms huge numbers of tracings with verfiable outcomes. Only the EKG can tell you OMI or Non-OMI. (It
There are no Q-waves to suggest old inferior MI, or inferior aneurysm as the etiology of the ST Elevation. Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. Truly, the Marquette 12 SL algorithm correctly identifies this STEMI. See reference and discussion below.
When there are QS-waves, one should always think about LV aneurysm, but ST to QRS ratio and T-wave to QRS ratio are far too large and not compatible with left ventricular aneurysm. 50% of LAD STEMI have Q-waves by one hour. There is some R wave in the lateral precordial leads. Leads V3 and V4 both have 6mm ST elevation.
The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". No thoracic aortic hematoma, aneurysm or dissection. Pt received 324 ASA and 2 sprays of nitro with improvement. Cath lab was activated by EMS and transported emergent." Pain was decreased to 2/10. CT Angio Chest IMPRESSION 1.
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