EMS 12-Lead

MAY 20, 2022

There is ventricular hypertrophy in the absence of abnormal loading conditions, such as aortic stenosis, or hypertension, for example – of which the most common variant is Asymmetric Septal Hypertrophy. There is LBBB-like morphology with persistent patterns of subendocardial ischemia.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain. 2] Here there is no posterior ST elevation, but the anterior ST depression is also less—so it is dynamic, confirming acute ischemia. But it is still STEMI negative.

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. 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." This is a very common misread. What do you think?

STEMI 40

STEMI Chest Pain Cardiac Arrest Stents 40

Dr. Smith's ECG Blog

OCTOBER 3, 2017

On arrival his BP was 70s/40s, so an intra-aortic ballon pump was placed. This means that they occur shortly after onset of occlusion, but also may be the last remaining sign of ischemia after ST elevation resolves (after reperfusion). A repeat ECG was done: Obvious anterolateral wall STEMI. This is diagnostic of re-occlusion.

Chest Pain 52

Chest Pain STEMI Defibrillator Blog 52

Dr. Smith's ECG Blog

JUNE 28, 2019

60-something with h/o MI and stents presented with chest pain radiating to the back and nausea/vomiting. There was concern for aortic dissection, so a CT was done and was negative. It was stented. The patient had a p rior h istory of MI + stents. More likely, these T waves probably reflect ischemia of uncertain age.

Chest Pain 52

Chest Pain Pericarditis Stents Stent 52

Dr. Smith's ECG Blog

SEPTEMBER 27, 2019

The first troponin returned at 0.099 ng/mL (elevated, consistent with Non-Occlusion MI) Providers were concerned with aortic dissection, so they order a chest aorta CT. This transmural ischemia, but not necessarily completed infarction (yet).

Chest Pain 52

Chest Pain Blog Ischemia Article 52

Dr. Smith's ECG Blog

OCTOBER 30, 2024

Ischemia often produces a straightening of the ST segment and sometimes upward convexity. At cath later the same day, a proximal 99% RCA culprit lesion was stented. And, even if there was acute aortic dissection — the dissection could result in occlusion of a coronary artery. Troponin T peaked at 4051 ng/L.

Chest Pain 111

Chest Pain Aortic Myocardial Infarction STEMI 111

Dr. Smith's ECG Blog

DECEMBER 3, 2024

His initial high sensitivity troponin I returned at 1300 ng/L and given that his cardiac workup was otherwise unremarkable, a CT was obtained to evaluate for pulmonary embolism and aortic aneurysm or dissection but this too was unrevealing. Another EKG was also obtained. ECG at time 82 minutes: What do you think?

Catheterization Laboratory 111

Catheterization Laboratory STEMI Blog Ischemia 111

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

There was some question of whether the patient was having abdominal pathology, and she also had a history of aortic pathology, so a chest abd/pelvic with aorta angiogram was ordered. It was opened and stented. If this were ACUTE (vs. SUBACUTE) OMI, that would result in an undesirable delay.

Blog 63

Blog Chest Pain Myocardial Infarction Critical Care 63