Circulation Nursing STEMI 
Dr. Smith's ECG Blog
OCTOBER 26, 2011
Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. Circulation 1999;99(15):1972-7.
Dr. Smith's ECG Blog
FEBRUARY 2, 2017
Discussion See this post: STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes I could find very little literature on the treatment of severe life-threatening hypokalemia. mEq of K pushed fast and circulated theoretically would raise serum K immediately by 1.0 and/or in the presence of acute MI. Is 40 mEq too much?
Dr. Smith's ECG Blog
NOVEMBER 30, 2019
She had home health nurse visits, and a BMP was sent the next day (the day prior to admission, presumably after 120 mEq of KCl replacement -- if she was taking as directed). to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 It would be difficult to get a nurse to give it faster! Is 40 mEq too much?
Dr. Smith's ECG Blog
APRIL 8, 2016
Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). There is atrial fibrillation.
Dr. Smith's ECG Blog
DECEMBER 11, 2023
She contacted her neighbor, a nurse, for help. Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Circulation , 130 (25). The patient presented to triage at around 10 PM.
Dr. Smith's ECG Blog
AUGUST 10, 2023
The nurse alerted the MD because the patient was still symptomatic, diaphoretic and “looking unwell”. This doesn’t meet STEMI criteria so in the current paradigm there’s no urgency to getting an angiogram. Discharge diagnosis was ‘STEMI’, even though no ECG ever met STEMI criteria. What do you think?
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. I'll never forget when I ordered such an infusion in 1991 and then my patient started seizing and I looked up and the nurse had hung the lidocaine wide open!
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