Remove Bradycardia Remove Myocardial Infarction Remove STEMI
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75 year old with 24 hours of chest pain, STEMI negative

Dr. Smith's ECG Blog

There’s sinus bradycardia, normal conduction, normal axis, delayed R wave progression, and normal voltages. The patient has a history of CABG so some of these changes could be old, but with ongoing chest pain and bradycardia in a high risk patient this is still acute OMI until proven otherwise. Inferior infarct, age undetermined.

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Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

ECG met STEMI criteria and was labeled STEMI by computer interpretation. This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern.

STEMI 52
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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. Turk Kardiyol Dern Ars.

STEMI 52
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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? 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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7 steps to missing posterior Occlusion MI, and how to avoid them

Dr. Smith's ECG Blog

Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. Step 1 to missing posterior MI is relying on the STEMI criteria. A prospective validation of STEMI criteria based on the first ED ECG found it was only 21% sensitive for Occlusion MI, and disproportionately missed inferoposterior OMI.[1]

STEMI 52
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46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. AIVR is not always the result of significant pathology, but is classically associated with the reperfusion phase of acute myocardial infarction. Is there STEMI? The patient continued having chest pain. Moffat, M.

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. No appreciable skin pallor. Is this OMI?