Dr. Smith's ECG Blog

JULY 25, 2024

Cardiac arrest #3: ST depression, Is it STEMI? Confirmation of sinus tachycardia should be easy to verify when the heart rate slows a little bit ( as the patient's condition improves ) — allowing clearer definition between the T and P waves. In this case, the cath lab was activated and the patient had a normal angiogram.

Cardiac Arrest 113

Cardiac Arrest Ischemia Tachycardia Defibrillator 113

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. In the available view of the sinus rhythm, we see normal variant STE which probably meets STEMI criteria in V4 and V5. Triage ECG: What do you think?

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Chest Pain Tachycardia STEMI Blog 122

Ken Grauer, MD

MAY 28, 2024

Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". Get a post -conversion 12-lead ECG — and compare this to the initial 12-lead ECG obtained during the tachycardia!

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Blog Arrhythmia Tachycardia CME 124

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

There was concern that the rhythm might represent ventricular tachycardia, so lidocaine was given and one attempt at cardioversion was performed. Peaked T waves: Hyperacute (STEMI) vs. Early Repolarizaton vs. Hyperkalemia What will you do for this altered and bradycardic patient? A Very Wide Complex Tachycardia.

Cardiac Arrest 137

Cardiac Arrest Bradycardia Tachycardia Chest Pain 137

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. At first glance, it seems the patient is having a STEMI. Then ACS (STEMI) might be primary; this might be cardiogenic shock.

STEMI 52

STEMI Cardiogenic Shock Tachycardia Aneurysm 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

So this NSTEMI was likely a STEMI(-)OMI with delayed reperfusion. The patient was admitted as ‘NSTEMI’ which is supposed to represent a non-occlusive MI, but the underlying pathophysiology is analogous to a transient STEMI. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?

Chest Pain 104

Chest Pain STEMI Aneurysm Stents 104

Dr. Smith's ECG Blog

APRIL 15, 2019

A prehospital ECG was recorded (not shown and not seen by me) which was worrisome for STEMI. Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. A near 60 year old male called 911 for increasingly severe fever and SOB.

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Tachycardia STEMI Chest Pain Ischemia 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

While the initial impression might not immediately suggest ventricular tachycardia (VT), a closer examination raises suspicion. Additionally, the qR morphology, particularly in a patient with right bundle branch block (RBBB) type wide QRS complex tachycardia (WQCT), lends further support for VT. What is the rhythm?

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Tachycardia Heart Failure Ischemia Blog 99

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. This progressed to electrical storm , with incessant PolyMorphic Ventricular Tachycardia ( PMVT ) and recurrent episodes of Ventricular Fibrillation ( VFib ). The below ECG was recorded. He required multiple defibrillations within a period of a few hours.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 116

Dr. Smith's ECG Blog

APRIL 12, 2013

A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. Here is his ED ECG: There is sinus tachycardia. Is this acute STEMI? Is this an acute STEMI? -- Unlikely! He had no chest pain.

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STEMI Pulmonary Stents Stent 52

Dr. Smith's ECG Blog

AUGUST 10, 2023

This doesn’t meet STEMI criteria so in the current paradigm there’s no urgency to getting an angiogram. The initial ECG suggested either subacute or reperfused inferoposterior occlusion and clearly does not meet traditional STEMI criteria. Discharge diagnosis was ‘STEMI’, even though no ECG ever met STEMI criteria.

Chest Pain 89

Chest Pain STEMI Ischemia Nursing 89

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? aVR ST Segment Elevation: Acute STEMI or Not?

Ischemia 52

Ischemia STEMI Stenosis Coronary Artery Disease 52

Dr. Smith's ECG Blog

MARCH 9, 2024

The cardiologist agreed that the ECG was suggestive of STEMI, but the facility's cath lab was apparently not available and he therefore recommended emergent transfer to a cath capable facility. Due to the chest pain radiating into the patient's back, the ER physician ordered CTA chest to rule out aortic dissection.

Chest Pain 113

Chest Pain Pericarditis Aortic Echocardiogram 113

Dr. Smith's ECG Blog

AUGUST 9, 2024

This has been discussed many times before on this blog. In-depth discussion is beyond the scope of this blog. Automatic activity refers to enhanced pacemaking function (typically from a non sinus node source), for example atrial tachycardia. Is there STEMI? The patient continued having chest pain. What is the rhythm?

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Chest Pain Arrhythmia Myocardial Infarction STEMI 88

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life. We've presented numerous examples of hyperkalemia on Dr. Smith's ECG Blog. The patient was treated.

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Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

Is this inferor STEMI? Tachycardia and ST Elevation. Atrial Flutter with Inferior STEMI? Inferolateral ST elevation, vomiting, and elevated troponin The treating team did not identify the flutter waves and they became worried about possible "STEMI" (despite the unusual clinical scenario). Long-term outcome is unknown.

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Atrial Flutter Ischemia STEMI Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 16, 2010

Here are more examples of wide complex tachycardia: these are all a mix of ventricular tachycardia and SVT with aberrancy. There is tachycardia, and there is a wide complex. This wide complex tachycardia could easily be misdiagnosed as V tach. This 51 yo male complained of chest pain, then had a v fib arrest.

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Tachycardia Cardiogenic Shock Chest Pain STEMI 52

Dr. Smith's ECG Blog

JUNE 17, 2024

for those of you who do not do Emergency Medicine, ECGs are handed to us without any clinical context) The ECG was read simply as "No STEMI." and tachycardia, 1.8. Finally , they found that S1Q3T3, precordial T-wave inversions V1-V4, and tachycardia were independent predictors of PE. inverted T-waves in V1 and V2, 1.8;

Chest Pain 139

Chest Pain Embolism Pulmonary Tachycardia 139

Dr. Smith's ECG Blog

MAY 30, 2024

Does the ECG represent STEMI-negative OMI findings? Putting all the findings together; dyspnea, slight tachycardia, delayed R-wave progression, prominent lateral S waves and ST depression maximal where the P waves are largest all point toward pulmonary disease as the cause of the ECG findings. How would you mange this patient?

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Ischemia Coronary Angiogram Pulmonary STEMI 74

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Here was the ECG: There is sinus tachycardia. So Shark Fin really is just a dramatic representation of STEMI, and can be in any coronary distribution. So this is STEMI, right? This was sent by a reader. A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. and K was normal. Which artery?

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Cardiogenic Shock STEMI Pericarditis Ischemia 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!) Code STEMI was activated. A man in his 80s with chest pain What, besides large anterior STEMI, is so ominous about this ECG? She was alert and oriented and hypotensive with initial BP 70/50.

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Cardiogenic Shock Chest Pain Tachycardia Ischemia 52

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? In addition to sinus tachycardia, the only abnormalities listed by the computer were "low voltage, precordial leads" and "anteroseptal infarct, old.Q Physician: "No STEMI."

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Chest Pain STEMI Document Ischemia 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. 2) Tachycardia to this degree can cause ST segment changes in several ways. Is that an obvious STEMI underneath that rhythm? If I fix the rhythm will the ST changes resolve?

Ischemia 52

Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

JULY 1, 2019

He commented: "by every measure, this would be RBBB with inferior and lateral STE appearing to be STEMI," but he also noted that there are several features that appear similar to false positives (like the first case above). There is also much STE in V3-V6, especially V4-V6, that must be considered to be STEMI. Peak troponin was 3.21

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Chest Pain Ischemia STEMI Blog 52

Dr. Smith's ECG Blog

OCTOBER 28, 2020

This ECG was texted to me with the implied question "Is this a STEMI?": I responded that it is unlikely to be a STEMI. Septal STEMI often has ST depression in V5, V6, reciprocal to V1. Then combine with clinical presentation and low pretest probability 2 Saddleback STEMIs A Very Subtle LAD Occlusion.T-wave wave in V1??

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STEMI Chest Pain Blog Tachycardia 52

Dr. Smith's ECG Blog

APRIL 12, 2023

Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam.

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Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease 52

Dr. Smith's ECG Blog

MARCH 1, 2023

During active chest pain an ECG was recorded: Meyers ECG interpretation: Sinus tachycardia, normal QRS complex, STD in V2-V6, I, II, III and aVF. A "STEMI alert" was called and soon cancelled. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. Pain lasted for approximately 45 minutes.

Chest Pain 52

Chest Pain Ischemia Stenosis Tachycardia 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2010

One might think this represents acute STEMI, or Bundle branch block with discordant ST segments and suspicously concordant T-waves. Upon arrival to the ED, he had the following 12-lead ECG: There is striking ST segment elevation in V1 and V2, with ST depression in V3-V6 as well as I, II, and aVF. There is also a wide QRS.

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Tachycardia Atrial Fibrillation STEMI Ablation 52

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.

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STEMI Chest Pain Stents Stent 52

Dr. Smith's ECG Blog

JUNE 17, 2018

There is sinus tachycardia. Sinus tachycardia, which exaggerates ST segments and implies that there is another pathology. I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. Here is that ECG: What do you think? See Table for diagnostic utility.

Chest Pain 52

Chest Pain Pericarditis Tachycardia Myocardial Infarction 52

BoardVitals - Cardiovascular

JANUARY 18, 2021

His exam was notable for tachycardia, elevated jugular venous pressure, diffuse rales, and an early 2/6 systolic murmur loudest at the cardiac apex. Explanation: The EKG illustrates an inferior STEMI. The post Cardiology Board Review Practice Questions appeared first on BoardVitals Blog. Severe mitral stenosis C.

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Bicuspid/Mitral Atrial Fibrillation Chest Pain Obesity 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? This is the response he got: Interventionist: "No STEMI, no cath. After stabilizing the patient and recording more ECGs, he tried again: Interventionalist: "It isn't a STEMI." It is a STEMI equivalent. We don't know how many though.

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STEMI Hospital Blog Defibrillator 52

EMS 12-Lead

APRIL 21, 2022

pre-existing, stable atherosclerosis) amidst any state of global duress – to include hypertension, hypoxia, tachycardia, hypotension, sepsis, and GI bleed, for example. STEMI was activated and the patient went to Cath on arrival. From Smith ECG Blog LCx occlusion There is aVR STE with broad STD, appreciable in both Leads II and V5.

Ischemia 52

Ischemia Myocardial Infarction Blog Coronary Angiogram 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0 Elevated troponin does not, however, guide any treatment strategies to minimize myocardial injury.

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The "criteria" for posterior STEMI are 0.5 Is it STEMI or NonSTEMI? The patient had no hypertension, no tachycardia, a normal hemoglobin, no drug use, no hypotension/shock, no murmur of aortic stenosis. The troponin I returned at 4.1 ng/mL (ULN = 0.030 ng/mL) , diagnostic of myocardial injury. mm STE in one lead.

Chest Pain 52

Chest Pain STEMI Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

There is an obvious inferior STEMI, but what else? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. This STE is diagnostic of Right Ventricular STEMI (RV MI). In fact, the STE is widespread, mimicking an anterior STEMI. EKG is pictured below: What do you think?

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Bradycardia Cardiogenic Shock STEMI Ischemia 52

Dr. Smith's ECG Blog

JUNE 17, 2017

There is sinus tachycardia. The possibility of anterior STEMI was not noticed during patient care. I saw this as I was reading a large a stack of ECGs: What do you think? The T-waves are slightly peaked, suggesting hyperkalemia. But what is atypical is that the T-wave in V3 towers over the R-wave. The QTc is 462 ms. It was stented.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Stents 52