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

Dr. Smith's ECG Blog

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.

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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

Here is the coronary angiogram: A distal thrombotic right coronary artery (RCA) occlusion ! The lesion was successfully stented. Here is the post-intervention angiogram and post-PCI ECG. Here is the post-intervention angiogram and post-PCI ECG. The pain was completely resolved after coronary intervention.

STEMI 52
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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

The cardiologist recognized that there were EKG changes, but did not take the patient for emergent catheterization because the EKG was “not meeting criteria for STEMI”. Troponin was elevated and no “STEMI” was seen on the EKG, so if it is acute MI, then “NSTEMI” is the diagnosis (however flawed), not a pathology on the differential.

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Distractions

EMS 12-Lead

He denied any known medical history, specifically: coronary artery disease, hypertension, dyslipidemia, diabetes, heart failure, myocardial infarction, or any prior PCI/stent. It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. No appreciable skin pallor. Is this OMI?

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A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

A CT Coronary angiogram was ordered. Here are the results: --Minimally obstructive coronary artery disease. --LAD Although a lesion is not visible anatomically on this CT scan, coronary catheter angiography could be considered based on Cardiology evaluation." Transient STEMI is at high risk of re-occlusion.

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A coronary angiogram, that tends to cross the boundaries of your thoughts

Dr. S. Venkatesan MD

Final message Coronary arterial anomaly is a less discussed topic nowadays, unless & until, it intrudes an interventional cardiologist in his daily routine life, of delivering stents. We know, how adverse is the outcome of Left main STEMI. In reality, there could be thousands of asymptomatic ones in the public domain.

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Hypertrophic Cardiomyopathy

EMS 12-Lead

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 coronary angiogram out of an abundance of caution.