Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. How do you explain the anterior STEMI(+)OMI immediately after ROSC evolving into posterior OMI 30 minutes later? This caused a type 2 anterior STEMI.

Cardiac Arrest 109

Cardiac Arrest STEMI Ischemia SCAD 109

Ken Grauer, MD

FEBRUARY 3, 2024

Despite the absence of significant coronary stenosis on her post-arrest cath — the ECG in Figure-1 is clearly diagnostic of an extensive anterolateral STEMI ( presumably from acute LAD [ L eft A nterior D escending ] coronary artery occlusion). The rhythm in ECG #1 is regular and supraventricular at a rate of ~75/minute.

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Blog Cardiac Arrest STEMI Plaque 163

Dr. Smith's ECG Blog

MAY 19, 2020

This is a troponin I level that is almost exclusively seen in STEMI. So this is either a case of MINOCA, or a case of Type II STEMI. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. I believe the latter (type II STEMI) is most likely.

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Circulation: Cardiovascular Interventions

OCTOBER 14, 2024

Circulation: Cardiovascular Interventions, Volume 17, Issue 10 , Page e014689, October 1, 2024.

STEMI 40

STEMI Cardiovascular Interventions Circulation 40

Circulation: Cardiovascular Interventions

APRIL 15, 2024

Circulation: Cardiovascular Interventions, Volume 17, Issue 4 , Page e014078, April 1, 2024.

STEMI 40

STEMI Cardiovascular Interventions Circulation 40

Circulation: Cardiovascular Imaging

NOVEMBER 29, 2024

Circulation: Cardiovascular Imaging, Volume 17, Issue 12 , Page e017611, December 1, 2024.

STEMI 40

STEMI Cardiovascular Imaging Circulation 40

Dr. Smith's ECG Blog

OCTOBER 8, 2024

Subtle as a STEMI." (i.e., Given that this is before it is released into the circulation by reperfusion therapy, this is a massively elevated troponin. In our study, there were 20/53 complete LAD OMI (TIMI-0 flow) which did not meet STEMI criteria. None of the 20 ever evolved to STEMI criteria. Hyperacute T-waves persist.

Cardiac Arrest 122

Cardiac Arrest Myocardial Infarction STEMI Cardiogenic Shock 122

Circulation: Cardiovascular Imaging

APRIL 3, 2025

Circulation: Cardiovascular Imaging, Ahead of Print. BACKGROUND:Microvascular obstruction (MVO) is associated with heart failure (HF) following ST-segmentelevation myocardial infarction.

Heart Failure 40

Heart Failure Myocardial Infarction STEMI Risk Factors 40

Circulation: Cardiovascular Interventions

FEBRUARY 20, 2024

Circulation: Cardiovascular Interventions, Ahead of Print.

STEMI 40

STEMI Physiology Cardiovascular Interventions Circulation 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. This has resulted in an under-representation of STEMI MINOCA patients in the literature. Circulation [Internet] 2017;135(16):1481–9. Circulation.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

AUGUST 19, 2023

This is diagnostic of infero-posterior OMI, but it is falsely negative by STEMI criteria and with falsely negative posterior leads (though they do show mild ST elevation in V4R). They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. Circulation 2007 2. Khan et al.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

JANUARY 2, 2016

LVH and the diagnosis of STEMI - how should we apply the current guidelines? This one mimics inferior STEMI (Figure 4): Concentric LVH, NO wall motion abnormality Case 5. Contrast the above with this one, which has both LVH and inferior STEMI : There is limb lead LVH with superimposed inferior STEMI. They are quite rare.

Ischemia 52

Ischemia Chest Pain STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

It has been estimated that in the aggregate, they occur at a rate of about 3 per 1000 patients with acute MI, and most of these events occur in patients with STEMI. A mong patients with STEMI, ventricular septal rupture is the most common and free wall rupture is the least common.

Cardiogenic Shock 109

Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

Dr. Smith's ECG Blog

MARCH 2, 2009

By definition, this is a non-STEMI because there is not 1 mm of ST elevation in 2 consecutive leads. However, ST elevation is only an imperfect surrogate for complete acute persistent occlusion of an epicardial coronary artery without collateral circulation. It is neither fully sensitive nor specific.

Heart Attack 52

Heart Attack Heart attacks STEMI Echocardiogram 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

Step 1 to missing posterior MI is relying on the STEMI criteria. A prospective validation of STEMI criteria based on the first ED ECG found it was only 21% sensitive for Occlusion MI, and disproportionately missed inferoposterior OMI.[1] But it is still STEMI negative. A 15 lead ECG was done (below). In a study last year, 14.4%

STEMI 52

STEMI Myocardial Infarction Chest Pain Ischemia 52

Open Heart

SEPTEMBER 13, 2024

This could facilitate the leakage of bacterial products into circulation and contribute to inflammation and adverse cardiac remodelling. Methods We examined 61 ST-elevation myocardial infarction (STEMI) patients who developed acute HF within 48 hours of successful percutaneous coronary intervention (PCI). to 264.65).

Cardiac Function 52

Cardiac Function Myocardial Infarction Heart Failure STEMI 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! Posterior STEMI occurs in approximately 15-20% of acute MI, but the vast majority of the time it is seen in conjunction with inferior (Infero-Posterior) or lateral (Postero-Lateral) STEMI (1).

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Ischemia 52

Dr. Smith's ECG Blog

JANUARY 1, 2013

Precordial ST depression may be subendocardial ischemia or posterior STEMI. If you thought it might be a posterior STEMI, then you might have ordered a posterior ECG [change leads V4-V6 around to the back (V7-V9)]. So there was 3-vessel disease, but with an acute posterior STEMI. Circulation 2007;115(10):1306-24.

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STEMI Ischemia Chest Pain Myocardial Infarction 52

Dr. Smith's ECG Blog

DECEMBER 29, 2023

But because there was no new ST elevation, the ECG was signed off as “STEMI negative” and the patient waited to be seen. But the ECG still doesn’t meet STEMI criteria. It was therefore interpreted as “no STEMI” and the patient was treated with dual anti-platelets and referred to cardiology as “NSTEMI.” the cardiologist 5.

Chest Pain 70

Chest Pain STEMI Myocardial Infarction Electrocardiogram 70

Dr. Smith's ECG Blog

APRIL 13, 2025

They recorded this ECG: Obvious inferior STEMI/OMI What else? The EMS ECGs: As per Dr. Smith the diagnosis of acute inferior STEMI is obvious from the history of new, severe CP in a patient with the initial EMS ECG that I show below ( TOP tracing in Figure-1 ). He called 911. Medics recorded a BP of 79/52 with pulse of 47.

Chest Pain 56

Chest Pain Embolism STEMI Plaque 56

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4141279-A4141279, November 12, 2024. Background:Slow flow phenomenon is impaired coronary flow during percutaneous coronary intervention (PCI) in absence of mechanical obstruction, and it is associated with deteriorated outcome.

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STEMI Myocardial Infarction Kidney Disease Thrombolysis 40

Dr. Smith's ECG Blog

MARCH 9, 2023

Barely any STE, and thus not meeting STEMI criteria. Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. He was given 6mg IV morphine for ongoing pain.

Chest Pain 52

Chest Pain STEMI Myocardial Infarction Blog 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The "criteria" for posterior STEMI are 0.5 Is it STEMI or NonSTEMI? It was opened and stented with a door to balloon time of about 120 minutes (this is long for STEMI, but very short for a high risk Non STEMI). The 4th, after the opening of the artery and release of troponin from the cardiac circulation, was 99.9

Chest Pain 52

Chest Pain STEMI Aortic Myocardial Infarction 52

Ken Grauer, MD

JANUARY 20, 2024

Another overlooked OMI ( Cardiologist limited by STEMI Definition — OMI evident by Mirror Test ) — See My Comment at the bottom of the page in the September 21, 2020 post on Dr. Smith’s ECG Blog. Smith’s ECG Blog.

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Blog Bradycardia STEMI Download 94

Dr. S. Venkatesan MD

SEPTEMBER 1, 2024

“ Since Intravenous lysis looks too simplistic, that do not need expertise, and lacks a commercial trail, it is wrongly depicted as inferior management strategy in STEMI “ Every one of us is equally responsible for this sorry state of affairs. In LAD STEMI time is more crucial. Circulation 2005;111:761-7.

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Thrombolysis Myocardial Infarction Academic STEMI 52

Ken Grauer, MD

MARCH 7, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery — as well as the importance of the term, " O MI" ( = O cclusion-based MI ) as an improvement from the outdated STEMI paradigm. ECG Blog #294 — How to tell IF the "culprit" artery has reperfused. ECG Blog #194 — AIVR as a sign that the "culprit" artery has reperfused.

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Blog Chest Pain STEMI Ischemia 78

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4140882-A4140882, November 12, 2024. Patients with documented STEMI, left ventricular thrombus, mechanical mitral or aortic valve replacement were excluded. Introduction:Atrial fibrillation (A fib) is the most common arrhythmia affecting 1-2% of the general population.

Stroke 40

Stroke Strokes Aortic valve Document 40

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

You've read in my previous posts that I have a lot of evidence that Wellens' represents spontaneously reperfused STEMI in which the STEMI went unrecorded. New ST elevation diagnostic of STEMI [equation value = 25.3 Circulation 1991;84:1454-1455. This T-wave inversion morphology is very specific for Wellens' waves.

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4147397-A4147397, November 12, 2024. Background:Ischemic heart disease (IHD) is a prevalent cardiovascular disease (CVD) associated with high morbidity and mortality. Over 600,000 percutaneous coronary interventions (PCI) are performed each year for IHD.

Heart Disease 40

Heart Disease Hospital Inpatient Outcomes 40

Dr. S. Venkatesan MD

MARCH 3, 2025

Is primary PCI superior to thrombolysis in the first hour of STEMI ? Circulation. No, it is not. I know, most interventional cardiologists cannot accept this fact and would strongly disagree. Still, they know very well there is no clear data to back up their belief. 2003 Dec 9;108(23):2851-6. doi: 10.1161/01.CIR.0000103122.10021.F2.

Hospital 40

Hospital Angioplasty Myocardial Infarction Thrombolysis 40

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4125093-A4125093, November 12, 2024. Types of ACS include stable angina 5.3% (n=8), unstable angina 24% (n=36), NSTEMI 28.7% (n=43), and STEMI 24% (n=36). Introduction:Inflammation plays an important role in the pathogenesis of coronary artery disease and Acute Coronary Syndrome (ACS).

Angina 40

Angina Coronary Artery Disease Biomarkers Atherosclerosis 40

Circulation

NOVEMBER 11, 2024

Circulation, Volume 150, Issue Suppl_1 , Page A4122543-A4122543, November 12, 2024. Background:Ticagrelor has been reported to cause shortness of breath (SOB) in 6 to 9 % of patients. Precise mechanisms are not enirely understood. The patient received ticagrelor in loading dose followed by 90 mg b.i.d plus low-dose aspirin.

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Exercise Blood Pressure STEMI Hypertension 40

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. On arrival, GCS was 13 and the patient complained of ongoing chest pain.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. He does have a recently diagnosed PE, and has not been taking his anticoagulation due to cost. He had a previous ECG on file: Proving the findings are new The cath lab was activated. He was given aspirin and sublingual nitro and the pain resolved.

Ischemia 121

Ischemia Plaque Stenosis Myocardial Infarction 121

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. This has resulted in an under-representation of STEMI MINOCA patients in the literature. Circulation [Internet] 2017;135(16):1481–9. Circulation.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

Dr. S. Venkatesan MD

MARCH 16, 2024

The role of collateral circulation in CTO that can compensate even during exercise is well known at patient level data. One more remote risk in CTO is, acute collateral shutdown causing STEMI/NSTEMI. (DECISION-CTO,EURO-CTO,EXPLORE,IMPACTOR) Opening a CTO, for reasons other than angina (i.e.

Angina 52

Angina Exercise Interventional Cardiology Academic 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

As per Dr. Aslanger — a number of medical providers were initial confused by what initially appears as marked ST elevation with reciprocal ST depression, indicative of an acute STEMI. That was also my initial concern. No "baseline" ECG is available for comparison.

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Tachycardia Blog Ischemia Heart Failure 112