Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Registry data indicate that 6–11% of patients with acute MI have nonobstructive coronary arteries.

Coronary Angiogram 109

Coronary Angiogram Plaque Thrombosis STEMI 109

Coronary Artery Disease Journal

NOVEMBER 20, 2023

Data were pooled and analyzed in terms of clinical outcomes to assess the impact of gender in patients with stable coronary artery disease and acute coronary syndrome. In the unmatched STEMI subgroup, all-cause mortality was significantly higher in females driven by older age (P < 0.001). vs. 5.2%; P = 0.749).

Stents 52

Stents Stent Outcomes Coronary Artery Disease 52

Frontiers in Cardiovascular Medicine

OCTOBER 7, 2024

BackgroundIn Thailand, access to specific pharmaceuticals and medical devices for ST-elevation myocardial infarction (STEMI) patients is restricted within certain healthcare systems, leading to inequalities in the quality of medical care among different healthcare systems.

Public Health 52

Public Health Myocardial Infarction STEMI Coronary Artery Disease 52

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

It does, in fact, the STE meets STEMI criteria since there is 1 mm of in V4 and V5. And you can see why: the artery may sponstaneously reperfuse, as it did here well before angiography, and documented with resolution of pain and evolution of the ECG to typical full reperfusion pattern Peak troponin I was 8544 ng/L. What did I say?

STEMI 131

STEMI Stenosis Plaque Chest Pain 131

Open Heart

JUNE 21, 2022

Background Several studies have demonstrated that complete revascularisation improves clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease. However, the optimal timing of non-culprit lesion revascularisation remains controversial.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Artery Disease Outcomes 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Written by Bobby Nicholson What do you think of this “STEMI”? Second, although there is a lot of ST Elevation which meets STEMI criteria, especially in V3-4, the ST segment is extremely upwardly concave with very large J-waves (J-point notching). With EMS, patient had a GCS of 3 and was saturating 60% on room air. ng/mL and 0.10

STEMI 116

STEMI Document Blog Ischemia 116

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. He reports that this chest pain feels different than prior chest pain when he had his STEMI/OMI, but is unable to further describe chest pain.

Chest Pain 135

Chest Pain Defibrillator STEMI Coronary Artery Disease 135

Coronary Artery Disease Journal

OCTOBER 30, 2023

Results Among the 277 patients diagnosed with AMI who underwent IPF testing, 113 had (STEMI) and 164 had (NSTEMI). Notably, among STEMI patients, those with IPF ≥ 4.2% Multivariate analysis identified patients with STEMI in the higher IPF group as one of the significant predictors for elevated peak troponin levels.

Myocardial Infarction 52

Myocardial Infarction STEMI 52

Coronary Artery Disease Journal

JUNE 10, 2024

Background Despite improvements in outcomes of ST elevation myocardial infarction (STEMI), ventricular septal rupture (VSR) remains a known complication, carrying high mortality. The contemporary incidence, mortality, and management of post-STEMI VSR remains unclear. In-hospital mortality was 73.6 ± 1.8%, but only 29.2 ± 1.9

Myocardial Infarction 40

Myocardial Infarction STEMI Outcomes Inpatient 40

Coronary Artery Disease Journal

APRIL 24, 2024

Purpose Construction of a prediction model to predict the risk of major adverse cardiovascular events (MACE) in the long term after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI).

Myocardial Infarction 40

Myocardial Infarction STEMI Diabetes Hypertension 40

Coronary Artery Disease Journal

NOVEMBER 26, 2023

Aim Acute injury and subsequent remodelling responses to ST-segment elevation myocardial infarction (STEMI) are major determinants of clinical outcome. Methods and results miRs were quantified in blood samples obtained from patients after primary PCI (PPCI) for STEMI.

Myocardial Infarction 40

Myocardial Infarction STEMI Biomarkers Outcomes 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

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.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

Coronary Artery Disease Journal

MAY 29, 2024

Background Despite advances in percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI), in-hospital mortality remains a concern, highlighting the need for the identification of additional risk factors such as serum iron levels. μmol/L) and a control group (Fe ≥7.8 μmol/L).

Myocardial Infarction 40

Myocardial Infarction Hospital STEMI Risk Factors 40

Dr. Smith's ECG Blog

MARCH 6, 2019

This is technically a STEMI, with 1.5 However, I think many practitioners might not see this as a clear STEMI, and would instead call this "borderline." They collected several repeat ECGs at the outside hospital before transport: None of these three ECGs meet STEMI criteria. This ECG was recorded on arrival: What do you think?

STEMI 52

STEMI Chest Pain Ischemia Myocardial Infarction 52

Circulation

NOVEMBER 11, 2024

Introduction:Inflammation plays an important role in the pathogenesis of coronary artery disease and Acute Coronary Syndrome (ACS). 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). The mean age of patients was 57.68 (SD= 11.19) years.

Angina 40

Angina Coronary Artery Disease Biomarkers Atherosclerosis 40

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. Studies of patients with coronary artery disease who developed arrhythmic storm with episodes of PMVT following MI — show arrhythmias indistinguishable from those reported in this case. The below ECG was recorded.

Arrhythmia 131

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 131

Dr. Smith's ECG Blog

MAY 23, 2014

However, there are also Q-waves inferiorly and the inferior T-waves are inverted, suggesting that this is an old MI with persistent ST elevation, or, alternatively, a subacute or partially reperfused, inferior STEMI. This is all but diagnostic of inferior-posterior STEMI. There is ST depression in V4-V6.

Ischemia 52

Ischemia Chest Pain STEMI Outpatient 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

One would expect that the angiogram would show open arteries with normal TIMI-3 flow and culprit lesions. 20% of cases that everyone would call a STEMI have a competely open artery by the time of angiogram 60-90 minutes later.

Chest Pain 119

Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

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

Dr. Smith's ECG Blog

APRIL 12, 2023

Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? Mild Plaque no angiographically significant obstructive coronary artery disease. She had acute pulmonary edema on exam.

Echocardiogram 52

Echocardiogram Pulmonary Cardiomyopathy Coronary Artery Disease 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

Here is the post shock ECG: Cardiology was called stat for ischemic VT, query SCAD vs thrombotic occlusion vs coronary vasospasm. Cath lab was activated: There was no coronary artery disease, but there was spontaneous coronary artery dissection (SCAD) of the distal LAD, which was narrowed by 95%, and treated medically.

Chest Pain 66

Chest Pain Pericarditis SCAD STEMI 66

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Registry data indicate that 6–11% of patients with acute MI have nonobstructive coronary arteries.

Plaque 52

Plaque Chest Pain Thrombosis Stenosis 52

EMS 12-Lead

MARCH 19, 2023

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.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

The British Journal of Cardiology

APRIL 16, 2024

Clinical presentation was stable angina 130/567 (22.9%), non-ST-elevation acute coronary syndrome (NSTEACS) 312/567 (55%), ST-elevation myocardial infarction (STEMI) 125/567 (22.0%), and STEMI with cardiogenic shock 13/125 (10.4%). The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,

Outcomes 40

Outcomes Cardiogenic Shock Angina STEMI 40

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. At 2111, the troponin I peaked at 12.252 ng/mL (this is in the range of STEMI patients, quite high).

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

OCTOBER 6, 2018

The patient was in his 50s with history of hypertension, diabetes, seizure disorder, and smoking, but no known coronary artery disease. He wrote in his note that "The EKG showed early repolarization in I, V2-V3 but no clear STEMI pattern." 418 of these 1788 (23%) had acute coronary occlusion.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 40

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 52

Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

MAY 10, 2023

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." It is likely that the artery will re-occlude.

Coronary Angiogram 52

Coronary Angiogram Chest Pain Stenosis STEMI 52

Dr. Smith's ECG Blog

APRIL 25, 2023

Smith and Meyers to diagnose both obvious (STEMI) and subtle OMI. But the stuttering pain and sudden onset suggest acute coronary occlusion (Occlusion MI, or OMI). "ECG Cath lab activation by the ED and I agree with coronary angiography emergently." Result: no angiographically significant obstructive coronary artery disease.

Chest Pain 52

Chest Pain Pericarditis Blog Cardiomyopathy 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused. Slow TIMI 2 initially with brisk flow status post percutaneous coronary intervention with 18mm drug-eluting stent.

Chest Pain 52

Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

APRIL 20, 2018

If she had no risk factors, it is doubtful that she would have developed such extensive coronary artery disease as we see on the angiogram. Patients like her are the reason we are advocating for a change in the ACS paradigm from STEMI to OMI. Her repeat ECHO showed an improving EF of 37%.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. What do you see?

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

The British Journal of Cardiology

NOVEMBER 10, 2023

Andreas Grüntzig, an ardent angiologist crafted an indeflatable sausage-shaped dual-lumen balloon-catheter, designed its delivery to the heart, launched minimally invasive coronary intervention and taught by beaming live demonstration. Subsequent advances are just incremental tweaks and tinkers around this fully formed framework from 1978.

Stents 40

Stents Stent Coronary Artery Disease Myocardial Infarction 40

Dr. Smith's ECG Blog

MARCH 2, 2019

Diffuse ST depression with ST elevation in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? Reference: Knotts RJ , Wilson JM, Kim E, Huang HD, Birnbaum Y. J Electrocardiol 2013;46:240-8. Hypokalemia is frequently forgotten as a cause of ST depression.

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Coronary Artery Disease Journal

NOVEMBER 1, 2023

However, the prognostic significance of NPS is unknown in ST-segment elevation myocardial infarction (STEMI). We aimed to analyze the prognostic value of the NPS in-hospital mortality in patients with STEMI. Methods The study consisted of 3828 patients diagnosed with STEMI who underwent primer percutaneous coronary intervention.

Myocardial Infarction 52

Myocardial Infarction Hospital STEMI Cancer 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2024

Written by Jesse McLaren, with edits from Meyers Four patients presented with chest pain or shortness of breath, and ECGs labeled ‘inferior STEMI’. Less concavity associated with hyperacuity This can help identify false negative STEMI, or STEMI(-)OMI, at risk for delayed reperfusion. More asymmetry 3.

STEMI 119

STEMI Chest Pain Pericarditis Coronary Artery Disease 119

Dr. Smith's ECG Blog

MARCH 14, 2025

He has a history of coronary artery disease and a STEMI two years prior that was treated with primary PCI. At the time of this initial ED ECG, his symptoms were improving ECG #1 on admission to the ED The patient was not seen quickly in the ED as it was a busy shift and the ECG did not meet STEMI criteria.

Chest Pain 106

Chest Pain STEMI Myocardial Infarction Ischemia 106