Cardiac Arrest, STEMI and Stenosis - Cardiovascular Update

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. This is FAR LESS than all other studies of shockable arrest. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. The proof of this is that only 5% of patients enrolled had acute coronary occlusion.

Defibrillator

Defibrillator Cardiac Arrest STEMI Chest Pain

ECG Blog #415 — The Cath showed NO Occlusion!

Ken Grauer, MD

FEBRUARY 3, 2024

Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. BUT — Cardiac catheterization done a little later did not reveal any significant stenosis. Figure-1: The initial ECG in today's case — obtained after successful resuscitation from cardiac arrest. (

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Blog Cardiac Arrest STEMI Plaque

Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?

Dr. Smith's ECG Blog

APRIL 24, 2015

ST depression is common BOTH after resuscitation from cardiac arrest and during atrial fib with RVR. Again, it is common to have an ECG that shows apparent subendocardial ischemia after resuscitation from cardiac arrest, after defibrillation, and after cardioversion. The patient was cardioverted. This was done.

Cardiac Arrest

Cardiac Arrest Defibrillator Atrial Fibrillation Ischemia

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50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. How do you explain the anterior STEMI(+)OMI immediately after ROSC evolving into posterior OMI 30 minutes later? This caused a type 2 anterior STEMI. TIMI-0 flow.

Cardiac Arrest

Cardiac Arrest STEMI Ischemia SCAD

Cardiac arrest: even after the angiogram, the diagnosis is not always clear

Dr. Smith's ECG Blog

OCTOBER 28, 2013

The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. The additional ST Elevation in V1 is not usually seen with diffuse subendocardial ischemia, and suggests that something else, like STEMI from LAD occlusion, could be present. Here is an article I wrote: Updates on the ECG in ACS. see below).

Cardiac Arrest

Cardiac Arrest Ischemia Defibrillator Electrocardiogram

Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Dr. Smith's ECG Blog

OCTOBER 4, 2010

An echocardiogram confirmed aortic stenosis with a large pressure gradient. Thus, this patient had increased ST elevation (current of injury) superimposed on the ST elevation of LVH and simulating STEMI. The next day, and angiogram showed normal coronary arteries. He awoke and did well.

Cardiac Arrest

Cardiac Arrest Ischemia Stenosis STEMI

Right Bundle Branch Block with Acute ST Elevation Seen Best on Prehospital ECG

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

RBBB in acute STEMI has a very high mortality. Angiography revealed a very tight LAD stenosis with some flow (confirming the reperfusion that we see on the ECG). Were it not for this prehospital ECG and the cardiac arrest, the diagnosis may have been significantly delayed.

Cardiac Arrest

Cardiac Arrest Chest Pain Defibrillator STEMI

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. Angiography : LMCA — 90-99% osteal stenosis. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain.

Arrhythmia

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator

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? His response: “subendocardial ischemia.

Ischemia

Ischemia STEMI Stenosis Chest Pain

PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don't miss case 4 at the bottom.

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

It may be difficult to read STEMI in the setting of RBBB. There is, however, a long QT also, with abnormal T-waves, but this is not STEMI. This ECG was recorded prehospital, and the computer read STEMI, so the medics activated the cath lab: What do you think? The ECG is consistent with high lateral STEMI. Called 911.

STEMI

STEMI Chest Pain Cardiac Arrest Stent

See what happens when hyperacute T-waves are missed

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

There is a very small amount of STE in some of the anterior, lateral, and inferior leads which do NOT meet STEMI criteria. The case was reviewed by all parties, and it was stated correctly that the ECG does not meet the STEMI criteria. The STEMI vs. NSTEMI paradigm is not the best way to decide who needs emergent reperfusion therapy.

Chest Pain

Chest Pain STEMI Cardiac Arrest Aneurysm

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. She was defibrillated and resuscitated. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

Plaque

Plaque Chest Pain Thrombosis Stenosis

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. I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. So this is either a case of MINOCA, or a case of Type II STEMI. If the arrest was caused by acute MI due to plaque rupture, then the diagnosis is MINOCA.

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

40-something with severe CP. True + vs. False + high lateral MI. ST depression does not localize.

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

He had a previous MI with cardiac arrest 2 years prior. Important Learning Point: "STEMI" is defined by millimeter criteria (1 mm in limb leads), which this does not meet. Therefore it is not a STEMI. The ST depression may be the most visibly obvious sign of STEMI. Some are STEMI-equivalents. RCA: dominant.

Ischemia

Ischemia Chest Pain STEMI Stenosis

ECG Blog #383 — Is this Coronary Disease?

Ken Grauer, MD

JUNE 6, 2023

But limitation of this ST elevation to a single lead is not consistent with any distribution of a STEMI. Unfortunately — the patient abruptly developed hypoxemia, followed by cardiac arrest with PEA. It was thought that this action precipitated the patient's desaturation, and led to his cardiac arrest.

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Blog Pulmonary Hypertension Aortic

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

Could this be Septal STEMI (STE in V1 and aVR, with reciprocal ST depression in V4-V6?), In Septal STEMI , transmural ischemia of the septum is recorded by the overlying lead V1 as ST Elevation. Lead III is also on the right and might manifest ST Elevation in Septal STEMI. with ADDED STE in III?

Ischemia

Ischemia Pulmonary STEMI Chest Pain

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

Dr. Smith's ECG Blog

APRIL 15, 2019

A prehospital ECG was recorded (not shown and not seen by me) which was worrisome for STEMI. A previous ECG from 4 years prior was normal: This looks like an anterior STEMI, but it is complicated by tachycardia (which can greatly elevate ST segments) and by the presentation which is of fever and sepsis.

Tachycardia

Tachycardia STEMI Chest Pain Ischemia

Guidelines would (erroneously) say that this patient who was defibrillated and resuscitated does not need emergent angiography

ECG Blog #415 — The Cath showed NO Occlusion!

Cardiac arrest, defibrillated, diffuse ST depression and ST Elevation in aVR. Why?

Webinars

50 yo with V fib has ROSC, then these 2 successive ECGs: what is the infarct artery?

Cardiac arrest: even after the angiogram, the diagnosis is not always clear

Cardiac Arrest, acute ST elevation and depression superimposed on LVH, but NOT due to ACS

Right Bundle Branch Block with Acute ST Elevation Seen Best on Prehospital ECG

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

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

PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don't miss case 4 at the bottom.

See what happens when hyperacute T-waves are missed

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

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

40-something with severe CP. True + vs. False + high lateral MI. ST depression does not localize.

ECG Blog #383 — Is this Coronary Disease?

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

Tachycardia, fever to 105, and ischemic ST Elevation -- a Bridge too Far

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