Remove Cardiac Arrest Remove Stent Remove Ultrasound
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Missed myocardial infarction with subsequent cardiac arrest

Dr. Smith's ECG Blog

He underwent coronary stenting (uncertain which artery). An emergency cardiac ultrasound could be very useful. Appreciation of these subtle ECG findings could have helped to avoid a cardiac arrest and its resulting permanent disability 3. I do not have the post-resuscitation ECG. Could this have been avoided?

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

The British Journal of Cardiology

We present the case of a man in his 50s, admitted with cardiac arrest secondary to inferolateral STEMI. Successful PPCI was performed via right femoral artery, with access gained under ultrasound guidance. The patient recovered successfully and was discharged two weeks later.

STEMI 52
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LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

Dr. Smith's ECG Blog

But the lack of traditional Sgarbossa criteria is not reassuring enough for such high pretest probability (elderly patient with chest pain, out of hospital cardiac arrest and LBBB), and the Modified Sgarbossa Criteria confirms Occlusion MI in this case. So the RCA was stented. Any indications for cath lab activation?

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STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. This was stented. If cardiac arrest from hypokalemia is imminent (i.e., As I indicated above, in our cardiac arrest case, after pushing 40 mEq, the K only went up to 4.2 He appeared to be in shock.

STEMI 52
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PseudoSTEMI and True ST elevation in Right Bundle Branch Block (RBBB). Don't miss case 4 at the bottom.

Dr. Smith's ECG Blog

A middle-aged male with h/o CAD and stents presented with typical chest pressure. A bedside ultrasound was done by the emergency physician, using Speckle Tracking. A male in late middle age with a history of RCA stent 8 years prior complained of chest pain. This is a very common misread. The trick is to find the end of the QRS.

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

Dr. Smith's ECG Blog

He had a previous MI with cardiac arrest 2 years prior. It was opened and stented. There was an old ECG for comparison: One year prior with no ST segment abnormalities A bedside cardiac ultrasound was done by the emergency physician. Culprit, stented) 3. A stent was placed and the patient became pain free.

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A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments

Dr. Smith's ECG Blog

His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. It was thought to be an in stent restenosis and thrombosis from a DES placed in the same region 6 months prior.