This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" Of course he said: "Yes, it was a 60 year old diabetic with Chestpain." That is not a STEMI. They had activated the cath lab and the interventionalist did not notice that it was not a STEMI/OMI. He said: "What?
A 70-something female with no previous cardiac history presented with acute chestpain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest.
Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.
Case An 82 year old man with a history of hypertension presented to the ED with chestpain at 1211. He described his chestpain as pleuritic and reported that it started the day prior while swinging a golf club. The ED provider ordered a coronary CT scan to assess the patient for CAD.
A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chestpain, shortness of breath, and diaphoresis after consuming a large meal at noon. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.
A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chestpain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go.
No prior exertional complaints of chestpain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. 50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. Pericarditis?
Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chestpain and normal vitals except tachycardia at about 115 bpm. Dr. Singer sent this to me with just the information: "~40 year old with acute chestpain". Emergent CT coronary angio also likely has a role in such cases.
Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chestpain and shortness of breath after finishing a 4-mile run. Ct coronaryangiogram showed normal coronary arteries. Anterior STEMI? He was discharged.
He has a history of STEMI and heart failure. The medics stated he had been nauseated and diaphoretic, but he did not have any chestpain or SOB. And especially suspect Old MI when the patient gives a history of MI and has no chestpain or SOB. A 50-something had syncope while driving. He had a prehospital ECG.
Here is the coronaryangiogram: A distal thrombotic right coronary artery (RCA) occlusion ! Here is the post-intervention angiogram and post-PCI ECG. The pain was completely resolved after coronary intervention. Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. 2021.21026.
Hospital evaluation for this patient was negative for an acute coronary syndrome ( ie, CT coronaryangiogram was normal — troponin was not elevated — and Echo was negative, with no sign of pericardial effusion ). I interpreted the ECG in Figure-1 as follows: The rhythm is sinus at ~65/minute.
CT coronaryangiogram — No obstructive coronary disease. CT coronaryangiogram showed no obstructive coronary disease. But immediate resolution of chestpain once VT was converted — and — the normal CT coronaryangiogram — essentially ruled out acute coronary disease as the cause.
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? Incidence of an acute coronary occlusion.
This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. As it currently stands, an ST/S ratio >15% should raise awareness for new anterior STEMI. Type II MI), however decided to pursue coronaryangiogram out of an abundance of caution. Below are two examples of this.
The medics were worried about STEMI, as it meets STEMI criteria. He denied chestpain or dyspnea throughout. Discussion Thus, no further ECGs were recorded and there was no angiogram or stress test or CT coronaryangiogram. There was no prodrome and no associated symptoms such as SOB or CP.
It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chestpain, weakness and nausea. Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. What do you see?
Case 1: 20-something woman with chestpain Case 2: 50-something man with chestpain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chestpain. They also recommended a NTG drip, after which she reported complete resolution of pain. She was a walk-in at triage.
A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chestpain and shortness of breath. She awoke in the morning with sharp chestpain which worsened throughout the morning. As her pain worsened, so did her dyspnea. Also see these posts of Type II STEMI.
The fear comes built in with the diagnosis often amplified by young felllows on call (& often times by senior consultants as well) It may appear real, from a clinical angle, but trust, when we deal with the whole gamut of so-called ACS (other than STEMI), there is indeed a benign face in many of them.
A 62 year old man with hyperlipidemia presented to a rural emergency department with 7 hours of 3/10 chestpain. At 1210, the case was discussed with a cardiologist at a PCI capable facility, who accepted the patient for transfer, noting the ST depression in anterior leads as consistent with ischemia but not a STEMI.
We organize all of the trending information in your field so you don't have to. Join thousands of users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
Let's personalize your content