Remove Bradycardia Remove Coronary Angiogram 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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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. Here is the coronary angiogram: A distal thrombotic right coronary artery (RCA) occlusion ! Here is the post-intervention angiogram and post-PCI ECG. The pain was completely resolved after coronary intervention. Turk Kardiyol Dern Ars.

STEMI 52
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What would you do with acute chest pain and this ECG? You might see what the Queen thinks.

Dr. Smith's ECG Blog

Three months prior to this presentation, he received a pacemaker for severe bradycardia and syncope due to sinus node dysfunction. The ED provider ordered a coronary CT scan to assess the patient for CAD. His EKG with worse pain now shows enough ST elevation to meet STEMI criteria. There is pericardial tamponade.

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Distractions

EMS 12-Lead

It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. Learning points 1] Acute Coronary Syndrome has many shades of clinical manifestation. This was all very alarming because his baseline routine, otherwise, is unencumbered as he reports a usually high exertional tolerance.