Cardiogenic Shock, STEMI and Stents - Cardiovascular Update

Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

Frontiers in Cardiovascular Medicine

MARCH 10, 2024

Background Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. 3.45) and 4.47 (95% CI: 2.54–7.87),

Myocardial Infarction

Myocardial Infarction Cardiogenic Shock Article Outcomes

3 days of shoulder and chest pain, and now cardiogenic shock

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." This can only be due to STEMI. Cardiogenic shock and ACS is an indication for the cath lab, even if you don't think there is OMI. I was texted these ECGs.

Cardiogenic Shock

Cardiogenic Shock Chest Pain Ischemia Stenosis

A man with chest pain off and on for two days, and "No STEMI" at triage.

Dr. Smith's ECG Blog

JUNE 19, 2023

This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 The Queen of Hearts sees it of course: Still none of these three ECGs meet STEMI criteria. Two stents were placed with resultant TIMI 3 flow. What do you think? Of course not.

Chest Pain

Chest Pain STEMI Cardiogenic Shock Ischemia

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

The British Journal of Cardiology

APRIL 16, 2024

Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intra-procedural complications. and the average number of stents 2.6. The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,

Outcomes

Outcomes Cardiogenic Shock Angina STEMI

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., She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. In our study, there were 20/53 complete LAD OMI (TIMI-0 flow) which did not meet STEMI criteria.

Cardiac Arrest

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock

ECG Blog #453 — Is this Wellens' Syndrome?

Ken Grauer, MD

OCTOBER 25, 2024

P.S.: Cardiac cath was performed — and showed a distal LA D "culprit" lesion that was successfully stented. It may look identical t o the ST-T wave appearance seen after a STEMI with marked troponin elevation, that has now reperfused ( be this reperfusion spontaneous — or by treatment with PCI or thrombolytics ).

Blog

Blog Chest Pain Cardiogenic Shock STEMI

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. The notes now refer to the patient being in cardiogenic shock, on pressors. Am J Emerg Med. 2014;32:e5–e8. J Cardiol Cases.

Chest Pain

Chest Pain Cardiogenic Shock Ischemia Myocardial Infarction

A man in his 70s with acute chest pain and paced rhythm.

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

Chest Pain Myocardial Infarction STEMI Pacemaker

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

Dr. Smith's ECG Blog

JUNE 11, 2021

The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Similarly, STEMI guidelines call for urgent angiography for refractory ischemia or electrical/hemodynamic instability, regardless of ECG findings. So the RCA was stented. Vitals were HR 58 BP 167/70 R20 sat 96%.

Chest Pain

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

There is an obvious inferior STEMI, but what else? Why is the patient in shock? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. He was in profound cardiogenic shock. This STE is diagnostic of Right Ventricular STEMI (RV MI). He was successfully stented.

Bradycardia

Bradycardia Cardiogenic Shock STEMI Ischemia

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

Dr. Smith's ECG Blog

MAY 30, 2023

There is an obvious inferior posterior STEMI(+) OMI. Angiogram: Culprit Lesion (s): Thrombotic occlusion of the proximal RCA -- stented. Results Of 149 patients with inferior STEMI , 43 (29%) had RVMI and 106 (71%) did not. What is the atrial activity? Is it sinus arrest with junctional escape? How would one tell?

Chest Pain

Chest Pain Myocardial Infarction STEMI Cardiogenic Shock

How does Acute Total Left Main Coronary occlusion present on the ECG?

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

Myocardial Infarction Ischemia STEMI Cardiogenic Shock

A man in his 70s with chest pain

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He was taken to the cath lab where he was found to have acute total occlusion of his saphenous vein graft to his RCA, which was stented. He was in cardiogenic shock requiring an impella for several days after cath. No further troponins were measured.

Chest Pain

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

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? Is this inferor STEMI? Atrial Flutter with Inferior STEMI? If I fix the rhythm will the ST changes resolve?

Ischemia

Ischemia Atrial Flutter Arrhythmia Tachycardia

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

distal stent patent. 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. The cath lab was activated. Angiogram: LM 30% ostial. Sandoval Y. Murakami M.

Myocardial Infarction

Myocardial Infarction Chest Pain Cardiogenic Shock STEMI

Stress hyperglycemia and poor outcomes in patients with ST-elevation myocardial infarction: a systematic review and meta-analysis

3 days of shoulder and chest pain, and now cardiogenic shock

A man with chest pain off and on for two days, and "No STEMI" at triage.

Outcomes of PCI of all comers: the experience of a Kuwaiti independent healthcare institution

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

ECG Blog #453 — Is this Wellens' Syndrome?

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

A man in his 70s with acute chest pain and paced rhythm.

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

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Chest pain and shock: Is there a right ventricular OMI on this ECG? And should he undergo trancutaneous pacing?

How does Acute Total Left Main Coronary occlusion present on the ECG?

A man in his 70s with chest pain

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Should Troponin be a Vital Sign? Perhaps, but only if Interpreted Using Pre-test Probability.

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