Dr. Smith's ECG Blog

APRIL 22, 2024

Patient still not having chest pain however this is more concerning for OMI/STEMI. Patient is pain free and clearly has Wellens' syndrome: 1) pain free episode following an episode of angina, typical Pattern A (biphasic, terminal T-wave inversion with an initial upsloping ST Segment) findings, preserved R-waves. Aspirin given.

Chest Pain 118

Chest Pain Myocardial Infarction Anatomy Angina 118

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. Approximately 48.5% of the patients were diagnosed with non-ST elevated myocardial infarction (NSTEMI), 36.8%

SCAD 75

SCAD Coronary Artery Bypass Graft Outcomes Myocardial Infarction 75

Dr. Smith's ECG Blog

MAY 20, 2024

If it is angina, lowering the BP with IV Nitroglycerine may completely alleviate the pain and the (unseen) ECG ischemia. The cardiologist recognized that there were EKG changes, but did not take the patient for emergent catheterization because the EKG was “not meeting criteria for STEMI”.

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

Dr. Smith's ECG Blog

MAY 1, 2016

Inferior STEMI without inferior ST elevation. The development of an inferior-posterior STEMI, from prehospital to hospital Case 6. A Case of Clinical Unstable Angina in the ED This case shows how hyperacute is only relative to the baseline T-waves. Is this STEMI? Subtle Inferoposterolateral STEMI

Chest Pain 52

Chest Pain STEMI Angina Hospital 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

Thus, the patient does not (yet) get a formal diagnosis of MI and must be called unstable angina unless further troponins return above the 99th percentile. On the basis of unresolved angina, cardiology decided to perform rescue PCI. Medically refractory angina should have immediate angiography, but this only happens 6.4%

Angina 121

Angina Plaque Document Stent 121

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. In addition, the criteria require the absence of precordial Q waves, the presence of history of angina, and normal or slightly elevated cardiac serum markers. ECG will remain same.

Anatomy 52

Anatomy Angina STEMI Thrombosis 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque 127

Plaque Angina Blog Stent 127

Dr. Smith's ECG Blog

AUGUST 9, 2024

The patient was given aspirin, heparin, morphine, and ondansetron and and transferred to a PCI-capable facility for a diagnosis of "unstable angina" with dynamic ECG changes. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI? What is the rhythm? Moffat, M.

Chest Pain 107

Chest Pain Arrhythmia Myocardial Infarction STEMI 107

Dr. S. Venkatesan MD

DECEMBER 2, 2023

This has important clinical significance , as many successfully lysed STEMI patient might have minimal segments of dissection/deep plaque fissures. , may be misdiagnosed as post infarct angina. Mind you, even if it occurs, it is atypical, continuous, non-anginal if flow is unaffected, and not relieved by nitro-glycerine.

SCAD 52

SCAD Plaque Angina Physiology 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

It has been estimated that in the aggregate, they occur at a rate of about 3 per 1000 patients with acute MI, and most of these events occur in patients with STEMI. A mong patients with STEMI, ventricular septal rupture is the most common and free wall rupture is the least common.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

The British Journal of Cardiology

APRIL 16, 2024

We present the cumulative percutaneous coronary intervention (PCI) data of all comers (stable angina and acute coronary syndromes [ACS]) who presented to Hadi Clinic between January 2018 and December 2020. The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6, and the average number of stents 2.6.

Outcomes 40

Outcomes Cardiogenic Shock Angina STEMI 40

Circulation

NOVEMBER 11, 2024

This study investigates the relationship between baseline 5-HTP levels and the incidence of major adverse cardiovascular events (MACE) in patients who have experienced ST-elevation myocardial infarction (STEMI).Objective:Our Conclusion:Higher 5-HTP levels are independently associated with a reduced risk of MACE in patients after STEMI.

Myocardial Infarction 40

Myocardial Infarction Coronary Artery Bypass Graft STEMI Angina 40

Dr. S. Venkatesan MD

MARCH 16, 2024

DECISION-CTO,EURO-CTO,EXPLORE,IMPACTOR) Opening a CTO, for reasons other than angina (i.e. One more remote risk in CTO is, acute collateral shutdown causing STEMI/NSTEMI. for relief of dyspnea or improving functional capacity) is largely conjectural and based on randomly accrued data backed by poor interpretation.

Angina 52

Angina Exercise Interventional Cardiology Academic 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

You've read in my previous posts that I have a lot of evidence that Wellens' represents spontaneously reperfused STEMI in which the STEMI went unrecorded. New ST elevation diagnostic of STEMI [equation value = 25.3 Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. There is no ST elevation.

STEMI 52

STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 6, 2019

This is technically a STEMI, with 1.5 However, I think many practitioners might not see this as a clear STEMI, and would instead call this "borderline." They collected several repeat ECGs at the outside hospital before transport: None of these three ECGs meet STEMI criteria. This ECG was recorded on arrival: What do you think?

STEMI 52

STEMI Chest Pain Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 14, 2018

This appears to be a classic Wellens' ECG, Pattern A, with terminal T-wave inversion in V2-V4, preserved R-waves, and it appears to be Wellens' syndrome, as it occurred after resolution of typical angina pain. Wellens' syndrome represents the aftermath of an unrecorded occlusion (STEMI) with spontaneous reperfusion.

Chest Pain 52

Chest Pain Angina Ischemia Stenosis 52

Dr. Smith's ECG Blog

APRIL 23, 2016

But beware the few false negatives, especially when there are hyperacute T-waves but no ST elevation (see Case 2 below): Formula to differentiate Normal Variant ST Elevation (Early Repolarization) from Anterior STEMI. 2 or 3 do not rule out unstable angina, even in the era of high sensitivity troponin: this study by Thelin et al.

Chest Pain 52

Chest Pain STEMI Angina Ischemia 52

Circulation

NOVEMBER 11, 2024

Types of ACS include stable angina 5.3% (n=8), unstable angina 24% (n=36), NSTEMI 28.7% (n=43), and STEMI 24% (n=36). The MACE was assessed 30-days after PPCI through phone calls with patients and confirmed from medical records.Results:The study included 150 patients with ACS, 82.7% (n= 124) of them were males.

Angina 40

Angina Coronary Artery Disease Biomarkers Atherosclerosis 40

Circulation

NOVEMBER 11, 2024

Patients were categorized as frail if they had a hospital frailty risk score (HFRS) of 5 or higher, and non-frail if their score was below 5.

Heart Disease 40

Heart Disease Hospital Inpatient Outcomes 40

Dr. Smith's ECG Blog

MARCH 9, 2013

Here is the prehospital ECG, with pain:  Hyperacute anterolateral STEMI  The medics had activated the cath lab and the patient went for angiogram and had a 95% stenotic LAD with TIMI-3 flow. When there is extremely brief ischemia, as in this case , or this case , it may entirely reverse, especially in unstable angina (negative troponins).

Chest Pain 52

Chest Pain Myocardial Infarction Ischemia Angina 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI. All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery?

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

While this ECG is negative for “posterior STEMI”, the resolution of anterior ST depression (accompanied by the troponin elevation) confirms posterior OMI with spontaneous reperfusion. The second opportunity to make the diagnosis and expedite angiography was missed because the ECG never met STEMI criteria and continued to be labeled ‘normal.’

STEMI 40

STEMI Myocardial Infarction Chest Pain Angina 40

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. He does have a recently diagnosed PE, and has not been taking his anticoagulation due to cost. He had a previous ECG on file: Proving the findings are new The cath lab was activated. He was given aspirin and sublingual nitro and the pain resolved.

Ischemia 122

Ischemia Plaque Stenosis Myocardial Infarction 122

Dr. Smith's ECG Blog

MARCH 11, 2016

A middle-aged woman had intermittent angina for 48 hours, then onset of constant, crushing chest pain for 1.5 cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." hours when she called 911. LV Thrombus , 1.5 0 0 1 95 544 MMRF 4 1 638 14.0

Myocardial Infarction 52

Myocardial Infarction Pericarditis Angina STEMI 52

Dr. Smith's ECG Blog

APRIL 22, 2022

The HEART and EDACS scores are helpful to risk stratify patients with chest pain, but they hinge on accurate ECG interpretation: a low score doesn’t apply if the ECG shows STEMI(+)OMI, and shouldn’t be used for STEMI(-)OMI or OMI reperfusion either 2. Specifying the level is more accurate, evidence-based and safe 3.

Chest Pain 52

Chest Pain Ischemia Myocardial Infarction Angina 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Takotsubo is a sudden event, not one with crescendo angina. 9 This dissociation between the degree of stenosis and the propensity to provoke an acute coronary syndrome helps to explain why myocardial infarction often occurs without being heralded by the demand-induced symptoms of angina that would result from a high-grade stenosis.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

JUNE 28, 2018

Angiographic and clinical characteristics of patients with unstable angina showing and ECG pattern indicating critical narrowing of the proximal LAD coronary artery. See these posts for Wellens' mimics: Pseudo-Wellens' Syndrome due to Left Ventricular Hypertrophy (LVH) Anterior STEMI? It even meets STEMI criteria: 2.5

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Article 52

Dr. Smith's ECG Blog

MAY 10, 2023

Later, she developed chest pain again, and had this ECG recorded: Obvious Anterior OMI that is also a STEMI Coronary angiogram- --Right dominant coronary artery system --The left main artery was normal in appearance and free of obstructive disease. --The Thus, Wellens' syndrome should be thought of as a transient OMI or transient STEMI.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

JULY 3, 2018

Despite ongoing chest discomfort and an uptrending troponin, he never meets STEMI criteria. As has been mentioned numerous times on this site and is redemonstrated here: expert, subjective ECG interpretation is superior to STEMI criteria. Despite having acute coronary occlusion by cath, his ECGs never met STEMI criteria.

Pericarditis 52

Pericarditis Chest Pain Stents Stent 52

Ken Grauer, MD

JULY 15, 2023

ECG Blog #337 — The importance of the new OMI ( vs the old STEMI ) Paradigm ( and My Comment in the July 31, 2020 post in Dr. Smith's ECG Blog ). == A DDENDUM ( 7/15/2023 ) : The original 3 ECGs in today's case were recorded using the Cabrera lead format.

Blog 78

Blog Coronary Angiogram Cardiomyopathy Ischemia 78

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). He presented with recent angina that evolved into a 3-hour episode of persistent CP unrelieved by rest. As per Drs.

Chest Pain 83

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 83

Dr. Smith's ECG Blog

JULY 31, 2018

It is equivalent to a transient STEMI. Not much, but studies of STEMI and NonSTEMI show that about 70% of those diagnosed with STEMI have a peak troponin I above 10 ng/mL and that about 70% of those diagnosed with NonSTEMI have a peak troponin I below 10 ng/mL. Again, cath lab was not activated. Int J Cardiol. 2016;207:341–348.

SCAD 52

SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

They recorded a prehospital ECG and diagnosed STEMI and activated the cath lab prehospital. The patient did not report angina with stress. male with a history of HTN and ETOH developed squeezing epigastric abdominal pain with associated vomiting and diaphoresis, followed by a syncopal episode which lasted about 10 seconds.

Chest Pain 40

Chest Pain Ischemia Angina Electrocardiogram 40

Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. There is no acute STEMI. This is diagnostic of recent, reperfused STEMI. This is diagnostic of recent, reperfused STEMI. Acute STEMI would have upright T-waves.

Chest Pain 40

Chest Pain STEMI Pericarditis Ultrasound 40

Open Heart

OCTOBER 23, 2024

Using person-linked hospitalisation data, we compared International Classification of Diseases (ICD)-coded data with biomarker-classified admission rates for ST-segment elevation MI (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in Western Australia (WA). Results There were 37 272 ACS admissions in 30 683 patients (64.2%

Biomarkers 52

Biomarkers Hospital STEMI Myocardial Infarction 52

Dr. S. Venkatesan MD

AUGUST 19, 2024

There is a problem here too ,even critical Ischemia with high grade unstable angina rarely trigger a VT but STEMI seems to have the exclusive rights to trigger it , by its ability to produce acute transmural ischemia.

Ischemia 52

Ischemia Sudden Cardiac Death Ablation Arrhythmia 52