Remove Bradycardia Remove Physiology Remove STEMI
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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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Distractions

EMS 12-Lead

Another factor to be considered, according to Chou’s textbook, is that many patients have dual AVN physiology and conduction is preferential down the fast pathway. It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. The shortened PR-interval is probably an accessory pathway.”

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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. Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The documentation does not describe any additional details of the history. The following ECG was obtained. ECG 1 What do you think?

Angina 109
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Chest pain and anterior ST depression. What’s the cause(s)?

Dr. Smith's ECG Blog

But it doesn’t meet STEMI criteria, and was not identified by the computer or the over-reading cardiologist. Still no WPW pattern, and more obvious inferoposterior OMI, but still STEMI negative. The emergency physician wasn’t sure what to make of the changes from one ECG to the next but was concerned about ACS. What do you think?