Aneurysm STEMI Stenosis 
Dr. Smith's ECG Blog
JANUARY 27, 2024
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.
Dr. Smith's ECG Blog
JUNE 18, 2011
This is a 45 yo male who had an inferior STEMI 6 months prior, was found to have severe LAD and left main disease, and was supposed to be set up for CABG a few weeks later, but did not follow up. But it could be anterior STEMI. 40% of anterior STEMI has upward concavity in all of leads V2-V6. is likely anterior STEMI).
Dr. Smith's ECG Blog
JANUARY 28, 2023
Only very slight STE which does not meet STEMI criteria at this time. I am immediately worried that this OMI will not be understood, for many reasons including lack of sufficient STE for STEMI criteria, as well as the common misunderstanding of "no reciprocal findings" which is very common with this particular pattern. 6.5 = 0.38.
Dr. Smith's ECG Blog
OCTOBER 15, 2024
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. Angiography revealed a 30% nonobstructive stenosis of the mid LAD.
Dr. Smith's ECG Blog
JULY 31, 2013
We have found in our study comparing inferior STEMI (manuscript in preparation) to inferior early repol several distinguishing characteristics. It showed a 99% stenosis in the RCA, and proximal to a posterolateral branch. A coronary aneurysm was found. Is this inferior ST elevation due to "early repolarization"? Lessons: 1.
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.
Dr. Smith's ECG Blog
MARCH 9, 2023
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.
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