Atrial Flutter Ischemia STEMI 
Dr. Smith's ECG Blog
FEBRUARY 9, 2024
Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. The first ECG was labeled “anterior subendocardial ischemia”, but subendocardial ischemia does not localize. What do you think?
Dr. Smith's ECG Blog
DECEMBER 26, 2020
There is the appearance of STE in inferior leads II, III, and aVF (with STD in aVR), but this is entirely due to flutter waves which are only seen in those leads. Also, the atrial flutter in this case is relatively slow like in many other cases we've shown. Is this inferor STEMI? Atrial Flutter with Inferior STEMI?
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. Therefore this patient is either in some form of SVT or atrial flutter. Atrial flutter, when regular, must be conducting at 1:1, 2:1, 3:1, etc.
Dr. Smith's ECG Blog
JUNE 27, 2021
If this STD were due to LVH or to subendocardial ischemia, rather than posterior OMI, it would be maximal in V5 and V6. By itself these would not be diagnostic as they do not have typical morphology (flat T-waves, possible atrial repolarization wave to account for ST depression). Because we are hypnotized the STEMI paradigm. "If
Dr. Smith's ECG Blog
MAY 8, 2023
Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). LAFB, atrial flutter, anterolateral STEMI(+) OMI.
Dr. Smith's ECG Blog
JULY 14, 2023
My interpretation was: RBBB with hyperacute T-waves in V4-V6 that are all but diagnostic of LAD occlusion vs. post ROSC ischemia. The patient had ROSC and maintained it. A 12-lead ECG was obtained: What do you think? Regional wall motion abnormality--apical anterior, mid anteroseptal, apical septal, and apical inferior akinesis.
Dr. Smith's ECG Blog
MAY 1, 2023
This narrows our differential for the rhythm down to sinus tachycardia, paroxysmal supraventricular tachycardia (PSVT, or SVT), and atrial flutter. The patient’s history is notable for paroxysmal atrial fibrillation, which raises clinical suspicion for atrial flutter, since these two entities frequently coexist on a spectrum.
Expert insights. Personalized for you.
114 
Let's personalize your content