Critical Care and Myocardial Infarction

Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association

Circulation

FEBRUARY 13, 2025

Critical care cardiology refers to the practice focus of and subspecialty training for the comprehensive management of life-threatening cardiovascular diseases and comorbid conditions that require advanced critical care in an intensive care unit. Circulation, Ahead of Print.

Critical Care

Critical Care Myocardial Infarction Research Cardiovascular Disease

Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry

Circulation: Cardiovascular Quality & Outcomes

JANUARY 5, 2024

Admissions to CICUs with the highest tertile of CCRx utilization had a greater burden of comorbidities, had more diagnoses of ST–elevation myocardial infarction, cardiac arrest, or cardiogenic shock, and had higher Sequential Organ Failure Assessment scores. CCRx was provided to 62.2% (interhospital range of 21.3%–87.1%)

Critical Care

Critical Care Cardiogenic Shock Academic Cardiac Arrest

Epigastric and Right Upper Quadrant pain after eating spicy food

Dr. Smith's ECG Blog

AUGUST 26, 2024

It turns out that the conventional algorithm was also worried, and because of that, the patient was brought to the critical care area. No Previous ECGs Available.

Myocardial Infarction

Myocardial Infarction Critical Care Echocardiogram Ischemia

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

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Optimizing Blood Transfusion in Patients with Acute Myocardial Infarction

The New England Journal of Medicine

DECEMBER 27, 2023

In 1999, Hébert and colleagues published their findings from the landmark Transfusion Requirements in Critical Care. It is also one of the most overused medical procedures, which largely neglects the associated risks, costs, and sustainability of liberal transfusion practices.

Myocardial Infarction

Myocardial Infarction Critical Care

An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Timing of revascularization in patients with transient ST segment elevation myocardial infarction: a randomized clinical trial. A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Lemkes et al. Eur Heart J 2018.

Chest Pain

Chest Pain Myocardial Infarction STEMI Pericarditis

Abstract TP82: Streamlining Stroke Transfers: Implementing RACE Score for Efficient Door in Door out in Primary to Comprehensive Stroke Centers

Stroke Journal

JANUARY 30, 2025

In May 2024, Community Medical Center, a primary stroke center in New Jersey, introduced a protocol to place critical care transport vehicles and/or a helicopter on standby when p[2] hysicians and paramedics identified a patient with stroke symptoms, an NIHSS >6 and a RACE score of >5.

Strokes

Strokes Stroke Myocardial Infarction Critical Care

A middle-aged man with acute chest pain.

Dr. Smith's ECG Blog

SEPTEMBER 1, 2023

The patient was moved to the critical care area (stabilization room). Angiogram Culprit Lesion (s): ST elevation myocardial infarction due to 99% stenosis of the distal LAD Formal echo: Normal estimated left ventricular ejection fraction, 63%. Cath lab was activated. A 2nd ECG recorded 50 minutes after the first.

Chest Pain

Chest Pain STEMI Stenosis Myocardial Infarction

Chest discomfort, Sinus Tachycardia, Q-waves, ST Elevation, and Intermittent Wide Complex Tachycardia. Activate the Cath Lab?

Dr. Smith's ECG Blog

AUGUST 13, 2020

Alternatively , it is someone who has an old myocardial infarction and is now very sick with something else. Today’s patient developed the series of 4 tachyarrhythmias shown above in the critical care area of the ED. Below is my response. There is sinus tach. There is an incomplete RBBB and LAFB.

Tachycardia

Tachycardia AFIB Cardiogenic Shock Myocardial Infarction

A female in her 60s who was lucky to get expert ECG interpretation

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Submitted and written by Alex Bracey, with edits by Pendell Meyers and Steve Smith: I was walking through the critical care section of the ED when I overheard a discussion about the following ECG. I had no history on the case and no prior ECG for comparison. What do you think? The initial ECG was taken at 0839.

Chest Pain

Chest Pain Critical Care Article Pacemaker

I was shown this ECG without any information. What do you think?

Dr. Smith's ECG Blog

NOVEMBER 8, 2022

He was moved to the critical care area due to his EKG. This was not a myocardial infarction of any kind. The patient had come to the ED for SOB, but without any chest pain. He has 3 weeks of progressive fatigue and weakness. He had a 10 pound weight loss. His potassium returned at 1.3 Learning Points: 1.

Article

Article Chest Pain Blog Myocardial Infarction

What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.

Dr. Smith's ECG Blog

MARCH 6, 2023

There was high suspicion of OMI, so patient was brought to critical care area and another ECG was recorded just 7 minutes later as the pain had diminished to 4/10. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. 2022.08.750 Section 5.2.2,

Chest Pain

Chest Pain STEMI Stenosis Blog

A "normal ECG" on a busy night

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We brought the patient into one of our critical care rooms and immediately got more history while recording this repeat ECG: The STE in I has greatly diminished or entirely disappeared. Acute myocardial infarction due to left circumflex artery occlusion and significance of ST-segment elevation. From AM et al.

Chest Pain

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

APRIL 8, 2016

Crit Care Med. 1991 May;19(5):694-9 Objective: To evaluate the efficacy and safety of potassium replacement infusions in critically ill patients. Setting: Multidisciplinary critical care unit. Literature on Hypokalemia as a risk for ventricular fibrillation in acute myocardial infarction.

STEMI

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

The patient arrived at the Emergency Dept critical care area and had this ECG recorded: The sinus bradycardia persists. Posterior wall involvement attenuates predictive value of ST-segment elevation in lead V4R for right ventricular involvement in inferior acute myocardial infarction.

Bradycardia

Bradycardia STEMI Cardiogenic Shock Ischemia

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Scott Rankin The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations The Annals of Thoracic Surgery November 2018 Alice Wang Robotic Mitral Valve Repair in Older Individuals: An Analysis of The Society of Thoracic Surgeons Database The Annals of Thoracic Surgery November 2018 Mohamad Alaeddine Aortic clamping strategy (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

Published Research

Society of Thoracic Surgeons - Research

APRIL 20, 2023

Scott Rankin The Impact of Mitral Disease Etiology on Operative Mortality After Mitral Valve Operations The Annals of Thoracic Surgery November 2018 Alice Wang 1 Robotic Mitral Valve Repair in Older Individuals: An Analysis of The Society of Thoracic Surgeons Database The Annals of Thoracic Surgery November 2018 Mohamad Alaeddine 1 Aortic clamping (..)

Research

Research Coronary Artery Bypass Graft Aortic valve Congenital

Chest pain and hypotension in a patient who is 3 weeks post STEMI

Dr. Smith's ECG Blog

JANUARY 28, 2012

Below are his presenting STEMI ECG and his post-PCI ECG from 3 weeks prior: Because of the hypotension, chest pain, and T-wave inversions, the physicians were worried about MI, took the patient to the critical care room, and called the cardiologists. However, these T-wave inversions should be expected at one month after MI.

Chest Pain

Chest Pain STEMI Pericarditis Ultrasound

Which patient needs a CT scan?

Dr. Smith's ECG Blog

DECEMBER 16, 2024

She had this ECG recorded: Obvious massive anterior STEMI She was quickly brought to the critical care area and the cath lab was activated. The blood pressure was 170/100 in the critical care area. She has no SOB and no prior medical history. Her initial BP was 203/124. Some Literature 1.3% Acta Cardiol. 2016;32:265272.

Chest Pain

Chest Pain STEMI Aortic Ultrasound

Chest (or abdominal?) pain and ECG artifact.

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

There was a previous ECG available for review: This shows baseline STE in inferior leads, including lead III.

Blog

Blog Chest Pain Myocardial Infarction Critical Care

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

Dr. Smith's ECG Blog

MARCH 8, 2025

The authors describe a case with some features in common with our patient -- a stressful event followed by a stress cardiomyopathy/acute myocardial infarction overlap syndrome. Acute myocardial infarction: an uncommon complication of takotsubo cardiomyopathy. Acute myocardial infarction triggered by emotional stress.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Cardiovascular Update

Evolution of Critical Care Cardiology: An Update on Structure, Care Delivery, Training, and Research Paradigms: A Scientific Statement From the American Heart Association

Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry

Epigastric and Right Upper Quadrant pain after eating spicy food

Webinars

Optimizing Blood Transfusion in Patients with Acute Myocardial Infarction

An elderly male with shortness of breath

Abstract TP82: Streamlining Stroke Transfers: Implementing RACE Score for Efficient Door in Door out in Primary to Comprehensive Stroke Centers

A middle-aged man with acute chest pain.

Chest discomfort, Sinus Tachycardia, Q-waves, ST Elevation, and Intermittent Wide Complex Tachycardia. Activate the Cath Lab?

A female in her 60s who was lucky to get expert ECG interpretation

I was shown this ECG without any information. What do you think?

What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.

A "normal ECG" on a busy night

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Published Research

Published Research

Chest pain and hypotension in a patient who is 3 weeks post STEMI

Which patient needs a CT scan?

Chest (or abdominal?) pain and ECG artifact.

Patient is informed of her husband's death: is it OMI or it stress cardiomyopathy?

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