Cardiac Arrest, Myocardial Infarction and STEMI

Missed myocardial infarction with subsequent cardiac arrest

Dr. Smith's ECG Blog

OCTOBER 24, 2013

Appreciation of these subtle ECG findings could have helped to avoid a cardiac arrest and its resulting permanent disability 3. Ischemia on the ECG can be very subtle and is easily missed. Accurate interpretation requires a lot of skill, practice, and experience.

Cardiac Arrest

Cardiac Arrest Myocardial Infarction Chest Pain Ischemia

How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Dr. Smith's ECG Blog

OCTOBER 8, 2024

Subtle as a STEMI." (i.e., About 45 minutes after the second EKG, the patient was found in cardiac arrest. Later the next day, she went into cardiac arrest again. By the time I saw the repeat EKG, the patient was already in cardiac arrest. None of the 20 ever evolved to STEMI criteria.

Cardiac Arrest

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock

Brachial artery approach for managing retroperitoneal bleed following coronary intervention for STEMI

The British Journal of Cardiology

NOVEMBER 29, 2023

Primary percutaneous coronary intervention (PPCI) remains the gold-standard treatment for ST-elevation myocardial infarction (STEMI). We present the case of a man in his 50s, admitted with cardiac arrest secondary to inferolateral STEMI.

STEMI

STEMI Cardiac Arrest Myocardial Infarction Ultrasound

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Variation in Likelihood of Undergoing Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction Among US Hospitals

Journal of the American Heart Association

FEBRUARY 19, 2025

BackgroundThere may be variability in willingness to perform percutaneous coronary intervention (PCI) in higherrisk patients who present with STsegmentelevation myocardial infarction (STEMI). There were 178 984 patients from 582 US hospitals presenting with STEMI who were included. versus 7.4%,P<0.001),

Myocardial Infarction

Myocardial Infarction Hospital STEMI Cardiac Arrest

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation.

Cardiac Arrest

Cardiac Arrest Chest Pain Defibrillator STEMI

75 year old dialysis patient with nausea, vomiting and lightheadedness

Dr. Smith's ECG Blog

AUGUST 19, 2023

This is diagnostic of infero-posterior OMI, but it is falsely negative by STEMI criteria and with falsely negative posterior leads (though they do show mild ST elevation in V4R). They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. Circulation 2007 2. Khan et al.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

This is a troponin I level that is almost exclusively seen in STEMI. In this case, profound shock for 1 hour would result in the same degree of infarction. I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. A followup ECG was recorded 2 days later: No definite evidence of infarction.

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

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

NOVEMBER 4, 2022

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?

Ischemia

Ischemia STEMI Stenosis Chest Pain

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored. Then they did an MRI: Patient underwent cardiac MRI on 10/4 that showed mildly reduced BiV systolic function. Such cases are classified as MINOCA (Myocardial Infarction with Non-Obstructed Coronary Arteries).

Plaque

Plaque Chest Pain Thrombosis Stenosis

ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

Dr. Smith's ECG Blog

JANUARY 4, 2021

Both of these patterns together suggest Aslanger's pattern , recently published in J Electrocardiology: A new electrocardiographic pattern indicating inferior myocardial infarction. Could this be Septal STEMI (STE in V1 and aVR, with reciprocal ST depression in V4-V6?), These suggest inferior OMI with possible RV involvement.

Ischemia

Ischemia Pulmonary STEMI Chest Pain

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). There is atrial fibrillation.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. For this reason, some argue that it should not be measured in patients unless acute myocardial infarction is on the differential diagnosis.

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

Machine-learning based risk prediction of in-hospital outcomes following STEMI: the STEMI-ML score

Frontiers in Cardiovascular Medicine

OCTOBER 9, 2024

The included variables were age, pre-hospital cardiac arrest, robust collateral recruitment (Rentrop grade 2 or 3), family history of coronary disease, initial systolic blood pressure, initial heart rate, hypercholesterolemia, culprit vessel, smoking status and TIMI flow pre-PCI. for in-hospital mortality, 0.78 for LVEF < 40%.

STEMI

STEMI Hospital ICU Outcomes

Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Also note that they allow ST depression c/w posterior MI to be a STEMI equivalent. What is the utility of a head CT in cardiac arrest?

Cardiac Arrest

Cardiac Arrest STEMI Hemorrhage Hospital

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

Circulation: Cardiovascular Interventions

FEBRUARY 20, 2024

BACKGROUND:Patients with ST-segment–elevation myocardial infarction but no coronary microvascular injury are at low risk of early cardiovascular complications (ECC). CONCLUSIONS:NH-IMRangiois a valuable risk-stratification tool in patients with ST-segment–elevation myocardial infarction.

Myocardial Infarction

Myocardial Infarction STEMI Cardiogenic Shock Cardiac Arrest

Chest Pain and Right Bundle Branch Block

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAH) on the admission ECG.

Chest Pain

Chest Pain Cardiac Arrest Myocardial Infarction Angioplasty

An intoxicated, agitated, 29 year old with chest pain

Dr. Smith's ECG Blog

MAY 13, 2017

Technically, the STE meets STEMI criteria because there is greater than 2.5 These kinds of cases were excluded from the study as obvious anterior STEMI. Differences in electrocardiographic Findings Between Acute Isolated Right Ventricular Myocardial Infarction and Acute Anterior Myocardial Infarction.

Chest Pain

Chest Pain STEMI Cardiac Arrest Myocardial Infarction

Another Inadequate Paper Published on Triage ECGs, whose Conclusions Need Scrutiny.

Dr. Smith's ECG Blog

OCTOBER 9, 2018

The utility of the triage electrocardiogram for the detection of ST-segment elevation myocardial infarction. link] In this paper, in a department in which they state they have only 50 STEMI per year, they looked at only 8 days worth of triage ECGs for a total of 538. They did not find one STEMI on their triage ECGs (no surprise!

Chest Pain

Chest Pain STEMI Cardiac Arrest Blog

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. Troponin T peaked at 38,398 ng/L ( = a very large myocardial infarction, but not massive-- thanks to the pre-PCI spontaneous reperfusion, and rapid internvention!! ). The below ECG was recorded. Inotropic medication was continued.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Acute myocardial infarction in patients with dialysis Patients on dialysis have a well studied history of underdiagnosis and undertreatment for acute myocardial infarction. Occlusion Myocardial Infarction (OMI) often does not present with diagnostic ST elevation, or even any STE, especially in dialysis patients.

Chest Pain

Chest Pain Myocardial Infarction Cardiac Arrest Ischemia

A Middle-Aged male with Chest Pain and an Unusual ECG

Dr. Smith's ECG Blog

MAY 6, 2019

If it is STEMI, it would have to be RBBB with STEMI. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. The patient presented with chest pain. Here is the ECG: What do you think? I frankly did not know what to think. Is it Brugada pattern? But in a very unusual pattern. Only 1-5% have OMI.

Chest Pain

Chest Pain STEMI Ischemia Myocardial Infarction

Heart Pump Improves Survival After Severe Heart Attacks

DAIC

APRIL 8, 2024

The new trial, called DanGer Shock , is the first trial powered to examine whether the use of micro-axial flow pumps can improve survival in ST-elevation myocardial infarctions (STEMI, the most serious type of heart attack) that are complicated by cardiogenic shock.

Heart Attack

Heart Attack Heart attacks Cardiogenic Shock Catheterization Laboratory

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

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. Code STEMI was activated. Plus recommendations from a 5-member panel on cardiac arrest. A man in his 80s with chest pain What, besides large anterior STEMI, is so ominous about this ECG? Eur Heart J.

Chest Pain

Chest Pain Cardiogenic Shock Tachycardia Ischemia

This ECG was texted to me after the fact with no information. What do you think?

Dr. Smith's ECG Blog

OCTOBER 13, 2023

There is worrisome T-wave inversion in inferior leads as well, which is another clue to LAD Occlusion In fact, this ECG meets STEMI criteria!! Why does the conventional algorithm not diagnose STEMI? Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04

Chest Pain

Chest Pain STEMI Cardiac Arrest Myocardial Infarction

Chest pain and hypotension in a patient who is 3 weeks post STEMI

Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. There is no acute STEMI. This is diagnostic of recent, reperfused STEMI. This is diagnostic of recent, reperfused STEMI. Acute STEMI would have upright T-waves.

Chest Pain

Chest Pain STEMI Pericarditis Ultrasound

When ACS care is very delayed, "STEMI metrics" can be perfect. And how specific is Queen of Hearts?

Dr. Smith's ECG Blog

MARCH 23, 2025

Here is the PMcardio Queen of Hearts interpretation of the ECG: STEMI equivalent detected. Inferior and posterior OMI without STEMI criteria. About an hour later another ECG was obtained: Barely meets STEMI criteria in inferior leads, but obvious inferior and posterior OMI. The cath lab was now activated for STEMI.

STEMI

STEMI Chest Pain Myocardial Infarction Article

The impact of the COVID-19 pandemic on ST-segment elevation myocardial infarction treatment strategy and outcomes

Frontiers in Cardiovascular Medicine

APRIL 15, 2025

p=0.025), in the COVID-19 pandemic group of STEMI patients, compared to the pre-pandemic subset. p=0.025), in the COVID-19 pandemic group of STEMI patients, compared to the pre-pandemic subset. These findings demonstrate the negative impact of the pandemic on treatment times and outcomes for patients diagnosed with STEMI.

COVID-19

COVID-19 Cardiogenic Shock Myocardial Infarction Cardiac Arrest

The effect of thermoelectric craniocerebral cooling device on protecting brain functions in post-cardiac arrest syndrome

Frontiers in Cardiovascular Medicine

JANUARY 8, 2025

AimThis study aimed to protect brain functions in patients who experienced in-hospital cardiac arrest through the application of local cerebral hypothermia. underwent emergency coronary angiography due to ST-elevation myocardial infarction (STEMI). Among the patients, 62.5%

Cardiac Arrest

Cardiac Arrest Myocardial Infarction Blood Pressure Hospital

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Dr. Smith's ECG Blog

APRIL 9, 2025

The paramedics diagnosis was "Possible Anterolateral STEMI." More proof that a huge STEMI may have normal or near normal initial troponin. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. The final angiographic result is very good.

Defibrillator

Defibrillator Cardiac Arrest STEMI Myocardial Infarction

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). Take home : Not all STEs are STEMIs or OMIs. What do you think?

STEMI

STEMI Bradycardia Cardiac Arrest Arrhythmia

Cardiovascular Update

Missed myocardial infarction with subsequent cardiac arrest

How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Brachial artery approach for managing retroperitoneal bleed following coronary intervention for STEMI

Webinars

Variation in Likelihood of Undergoing Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction Among US Hospitals

A 40-something presented after attempted prehospital resuscitation with persistent Ventricular Fibrillation

75 year old dialysis patient with nausea, vomiting and lightheadedness

1 hour of CPR, then ECMO circulation, then successful defibrillation.

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

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Extreme shock and cardiac arrest in COVID patient

Machine-learning based risk prediction of in-hospital outcomes following STEMI: the STEMI-ML score

Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?

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

Chest Pain and Right Bundle Branch Block

An intoxicated, agitated, 29 year old with chest pain

Another Inadequate Paper Published on Triage ECGs, whose Conclusions Need Scrutiny.

What are treatment options for this rhythm, when all else fails?

A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

A Middle-Aged male with Chest Pain and an Unusual ECG

Heart Pump Improves Survival After Severe Heart Attacks

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

This ECG was texted to me after the fact with no information. What do you think?

Chest pain and hypotension in a patient who is 3 weeks post STEMI

When ACS care is very delayed, "STEMI metrics" can be perfect. And how specific is Queen of Hearts?

The impact of the COVID-19 pandemic on ST-segment elevation myocardial infarction treatment strategy and outcomes

The effect of thermoelectric craniocerebral cooling device on protecting brain functions in post-cardiac arrest syndrome

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Unconscious + STEMI criteria: activate the cath lab?

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