Remove Bradycardia Remove Cardiogenic Shock Remove STEMI
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A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 Soon afterward, the patient’s symptoms return along with lightheadedness, bradycardia, and hypotension. The Queen of Hearts sees it of course: Still none of these three ECGs meet STEMI criteria.

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A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

There is an obvious inferior STEMI, but what else? Why is the patient in shock? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. He was in profound cardiogenic shock. This STE is diagnostic of Right Ventricular STEMI (RV MI). Here is full text of this article.

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What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. There was no evidence bradycardia leading up to the runs of PMVT ( as tends to occur with Torsades ).

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Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

Here is his ED ECG: There is bradycardia with a junctional escape. There is an obvious inferior posterior STEMI(+) OMI. Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. RVMI explains part of the shock. He appeared gray in color, with cool skin. What is the atrial activity?

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The ECG told the whole story, but no one listened: ECG interpretation skills are critical to patient outcomes.

Dr. Smith's ECG Blog

Then the notes mention "cardiogenic shock" but without any reference to a cardiac echo or to a chest x-ray. Cardiologist note says: "Elevated troponin explained by type II MI due to her shock." Trop T now very high, well into the range one sees with a STEMI; very unusual in type II MI. There is a junctional bradycardia.