Remove Cardiac Arrest Remove Cardiogenic Shock Remove STEMI
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A man in his 50s with unwitnessed VF arrest, defibrillated to ROSC, and no STEMI criteria on post ROSC ECG. Should he get emergent angiogram?

Dr. Smith's ECG Blog

Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. Despite anticipation by many that the initial post-resuscitation ECG will show an obvious acute infarction — this expected "STEMI picture" is often not seen.

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Heart Pump Improves Survival After Severe Heart Attacks

DAIC

milla1cf Mon, 04/08/2024 - 18:07 April 8, 2024 — Implantation of the Impella CP micro-axial flow pump in the hours after a heart attack significantly increased the rate of survival at six months among people suffering cardiogenic shock, according to a study presented at the American College of Cardiology ’s Annual Scientific Session.

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Angiography-Derived Index of Microcirculatory Resistance to Define the Risk of Early Discharge in STEMI

Circulation: Cardiovascular Interventions

NH-IMRangiowas calculated based on standard coronary angiographic views with 3-dimensional-modeling and computational analysis of the coronary flow.RESULTS:Overall, ECC (a composite of cardiovascular death, cardiogenic shock, acute heart failure, life-threatening arrhythmias, resuscitated cardiac arrest, left ventricular thrombus, post-ST-segment–elevation (..)

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Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

Lactate was 20, POC Cardiac US showed EF estimated at 30%, and formal echo showed EF of only 15%, and a normal RV. Assessment was severe sudden cardiogenic shock. In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease.

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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. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck.

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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. aVR ST segment elevation: acute STEMI or not? aVR ST Segment Elevation: Acute STEMI or Not?

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An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex

Dr. Smith's ECG Blog

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenic shock but awake. Code STEMI was activated. Plus recommendations from a 5-member panel on cardiac arrest.