Remove Bradycardia Remove Myocardial Infarction Remove Stent
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A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

Both of these features make inferior + RV MI by far the most likely ( Pseudoanteroseptal MI is another name for this ) There is also sinus bradycardia and t he patient is in shock with hypotension. A narrow complex bradycardia without any P-waves is also likely to respond to atropine, as it may be a junctional rhythm.

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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Dr. Smith's ECG Blog

Case continued Another ECG was recorded 3 hours later, still 1/10 pain: There is sinus bradycardia with RBBB. So we know there is myocardial infarction and the patient has persistent pain, but it is very mild. The culprit was opened and stented. They only mask the underlying pathology.

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Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Dr. Smith's ECG Blog

Electrocardiographic Criteria to Differentiate Acute Anterior ST Elevation Myocardial Infarction from Left Ventricular Aneurysm. Former resident: "Just saw cath report, LAD stent was 100% acutely occluded." They of course opened and stented it. American Journal of Emergency Medicine 2005; 23(3):279-287.

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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. No appreciable skin pallor. He reported to be a social drinker, but used tobacco products daily. Here is the time-zero 12 Lead ECG.

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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. Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. He appeared gray in color, with cool skin. What is the atrial activity? Worrall , Stephen W.

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Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

The ECG shows sinus bradycardia but is otherwise normal. So there is probability of myocardial injury here (and because it is in the correct clinical setting, then myocardial infarction.) On the combined basis of angiography and IVUS, this patient received stents to his mid RCA, proximal PDA, and OM.

Angina 109
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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

Smith , d and Muzaffer DeÄŸertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. The lesion was successfully stented. As he seemed very agitated, fentanyl and diazepam were given.

STEMI 52