Dr. Smith's ECG Blog

MAY 30, 2023

What is the atrial activity? Or is it atrial fibrillation with complete AV block and junctional escape? There is an obvious inferior posterior STEMI(+) OMI. Results Of 149 patients with inferior STEMI , 43 (29%) had RVMI and 106 (71%) did not. Here is his ED ECG: There is bradycardia with a junctional escape.

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

OCTOBER 28, 2013

The rhythm is nearly regular, but there are no P-waves (it is too regular to be atrial fibrillation). The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. The patient had a combined respiratory and metabolic acidosis (as we commonly find in those with prolonged arrest), and a K of 4.1,

Cardiac Arrest 52

Cardiac Arrest Ischemia Defibrillator Electrocardiogram 52

ECG Cases

OCTOBER 17, 2023

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV (..)

Pericarditis 106

Pericarditis AFIB Blog Atrial Fibrillation 106

ECG Cases

JULY 18, 2023

On this month's EM Quick Hits podcast David Carr on differential diagnosis of normal unenhanced CT renal colic, Leeor Sommer on recognition and management of perichondritis and auricular abscess, Suzanne Schuh on IV magnesium sulphate for pediatric asthma, Jess McLaren on Occlusion MI ECG interpretation requiring cath lab activation and Justin Morgenstern (..)

Pediatrics 96

Pediatrics Chest Pain Atrial Fibrillation STEMI 96

Dr. Smith's ECG Blog

MAY 1, 2023

edits by Meyers A woman in her 60s with a history of chronic atrial fibrillation on Eliquis, ESRD on hemodialysis, type-II diabetes mellitus, prior CVA, hypertension, and hyperlipidemia presented to the emergency department with multiple complaints after missing dialysis. Is this inferor STEMI? Christmas Eve Special Gift!!

Atrial Flutter 52

Atrial Flutter Tachycardia Arrhythmia Blog 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

He was brought to the critical care area where these rhythms were seen on the monitor: Wide complex tachycardia with no apparent P-waves, and very irregular Consistent with atrial fibrillation with aberrancy A Regular wide complex tachycardia. Looks like atrial fibrillation. LV Aneurysm? Would you give Thrombolytics?

Tachycardia 52

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. Look at the aortic outflow tract. What do you see? Answer below in the still shot.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

AUGUST 28, 2020

This can only be due to STEMI. ECG from 2 days later: Atrial Fibrillation now. However, cardiogenic shock usually takes some time to develop, so it is probably subacute." Then I was told that the troponin I returned at greater than 50,000 ng/L. I said "activate the cath lab." Circumflex occlusion may have minimal ECG findings.

Cardiogenic Shock 40

Cardiogenic Shock Chest Pain Ischemia Stenosis 40

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? There is atrial fibrillation. to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 The corrected QT interval is extremely long, about 500 ms. The QT is much shorter still.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

JULY 7, 2013

Here is his ECG: There is atrial fibrillation at a rate of 95. Thus, this is both an anterior and inferior STEMI. How old is this antero-inferior STEMI? Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Exact pain history was difficult to ascertain. There was some SOB.

STEMI 52

STEMI Myocardial Infarction Pericarditis Ultrasound 52

Dr. Smith's ECG Blog

JULY 18, 2014

Description There is atrial fibrillation at a rate of 95. 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. He had walked into the ED (did not use EMS).

STEMI 52

STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

BoardVitals - Cardiovascular

JANUARY 18, 2021

ACS QID 75345 In 2017, the New England Journal of Medicine published the results of the Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation (RE-DUAL PCI) trial. Explanation: The EKG illustrates an inferior STEMI. Severe mitral stenosis C. Hyperdynamic ventricle D. Acute mitral regurgitation E.

Bicuspid/Mitral 52

Bicuspid/Mitral Atrial Fibrillation Chest Pain STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. Chart review confirmed that he had been started on flecainide for atrial fibrillation. Is that an obvious STEMI underneath that rhythm? Is this inferor STEMI?

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

All About Cardiovascular System and Disorders

MARCH 28, 2024

So this is a typical Brugada syndrome ECG, which can be easily mistaken for an acute myocardial infarction with ST elevation in anterior leads may be taken as STEMI if the person presents with chest pain for some other reason. Of course, the commonest sustained arrhythmia in general population is atrial fibrillation.

Sudden Cardiac Death 52

Sudden Cardiac Death Defibrillator Arrhythmia Atrial Fibrillation 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

The rhythm is atrial fibrillation. Initial ROSC was obtained, during which this ECG was obtained: What do you think? Meyers interpretation: This is a complicated interpretation made even more so by the fact that it is immediately post ROSC. The QRS complex is within normal limits.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

underlying atrial fibrillation or atrial inactivity). And, in cases like the elderly patient with new-onset chest pain presented here — definitive diagnosis of acute STEMI is sometimes deceptively easy. BOTTOM LINE: Despite cardiac pacing — ECG #2 is diagnostic of a very large acute anterior STEMI.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

The computer called this Acute STEMI What do you think? STEMI never has a very short QT. There is Bazett, Fridericia, Hodges, Framingham and Rautaharju -- see here at mdcalc: [link] If the ST Elevation here were due to STEMI, it would be an LAD Occlusion.

Chest Pain 52

Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

MARCH 3, 2025

Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. An EKG from a year prior was available for comparison: The ED physician noted Initial EKG here read by the computer as a STEMI, however, there is a very poor baseline and a lot of artifact. See reference and discussion below.

Tachycardia 73

Tachycardia Pulmonary Chest Pain Stenosis 73

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). Take home : Not all STEs are STEMIs or OMIs. What do you think?

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Dr. Smith's ECG Blog

MARCH 8, 2025

2:34 PM, following right heart catheterization She then went into atrial fibrillation with complete heart block and junctional escape rhythm prompting placement of transvenous pacemaker. There was indication of parasympathetic overdrive ( the acute inferior STEMI with profound bradycardia and junctional escape ).

Cardiomyopathy 74

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia 74