Dr. Smith's ECG Blog

MAY 30, 2023

There is an obvious inferior posterior STEMI(+) OMI. Methods Retrospective study of consecutive inferior STEMI , comparing ECGs of patients with, to those without, RVMI, as determined by angiographic coronary occlusion proximal to the RV marginal branch. What is the atrial activity? Is it sinus arrest with junctional escape?

Chest Pain 97

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock 97

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The ECG was read as "No STEMI" and the patient was treated like an average chest pain patient (despite the fact that a chest pain patient with active pain and active subendocardial ischemia is very high risk). The notes now refer to the patient being in cardiogenic shock, on pressors.

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Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction 82

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?

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Ischemia STEMI Stenosis Chest Pain 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He was in cardiogenic shock requiring an impella for several days after cath. Sooner identification likely leads to better outcomes, and in this case may have allowed prevention of cardiac arrest and better long-term outcome. No further troponins were measured. Such is the situation in today's post by Drs.

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Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

A recent study found that SCAD causes almost 20% of STEMI in young women. examined SCAD presenting as STEMI (unlike Hassan et al. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. I had no idea SCAD was so common a cause of acute STEMI in younger women, even when they are non-smokers.

Chest Pain 52

Chest Pain SCAD STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. Long term outcome is unavailable. So the cath lab was activated.

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Chest Pain STEMI Cardiogenic Shock Heart Failure 121

Dr. Smith's ECG Blog

JULY 18, 2014

Thus, this is BOTH an anterior and inferior STEMI in the setting of RBBB. How old is this antero-inferior STEMI? Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Could it be acute (vs.

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STEMI Pericarditis Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Assessment was severe sudden cardiogenic shock. However, in multiple studies, even in the absence of AMI, both acute and chronic myocardial injury (as diagnosed by any elevated cTn) are powerful markers of adverse outcomes in both the short and long term. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). LAFB, atrial flutter, anterolateral STEMI(+) OMI. Limkakeng AT.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI. All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery?

Myocardial Infarction 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. Is that an obvious STEMI underneath that rhythm? Again, not an expected outcome with diltiazem). Is this inferor STEMI? Atrial Flutter with Inferior STEMI?

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Ischemia Atrial Flutter Arrhythmia Tachycardia 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

PCI mid LCx So this is an OMI (Occlusion Myocardial Infarction), but not a STEMI Echo: Decreased left ventricular systolic performance, mild/moderate. The patient went into cardiogenic shock and ultimately died of this MI. Angiogram: LM 30% ostial. LAD 80% mid LCx occluded mid (acute infarct lesion) RCA 80% mid. Sandoval Y.

Myocardial Infarction 52

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI 52

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.

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COVID-19 Cardiogenic Shock Myocardial Infarction Cardiac Arrest 52

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. Truly, the Marquette 12 SL algorithm correctly identifies this STEMI.

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Tachycardia Pulmonary Chest Pain Stenosis 73

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. But it does show a strong association of better outcome with lidocaine vs. amiodarone. I don't know what the device algorithm interpretation stated. Smida T et al.

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Defibrillator Cardiac Arrest Myocardial Infarction STEMI 63

Dr. Smith's ECG Blog

APRIL 16, 2025

. _ Here is the Queen of Hearts interpretation, appropriately reading STEMI equivalent, highlighting anterior and lateral leads with explainability, and even detecting reduced LVEF. The Cardiologist stated that the ECG did not show signs of STEMI, but rather NSTEMI, recommended serial ECGs and troponins, and cancelled the activation request.

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Chest Pain STEMI Tachycardia Cardiac Arrest 66