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. 3) STEMI criteria failed to identify this acute coronary occlusion, like many others. What do you think?

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Chest Pain Critical Care Article Pacemaker 52

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. Here is the repeat ECG at 52 minutes after arrival to triage: Obvious posterolateral STEMI Angiographic findings: 1. V5 and V6 have hyperacute T-waves.

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Dr. Smith's ECG Blog

AUGUST 13, 2020

He was brought to the critical care area where these rhythms were seen on the monitor: Wide complex tachycardia with no apparent P-waves, and very irregular Consistent with atrial fibrillation with aberrancy A Regular wide complex tachycardia. Instead, he complained of left chest "itchiness". LV Aneurysm? Would you give Thrombolytics?

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Dr. Smith's ECG Blog

NOVEMBER 1, 2022

This EKG was recorded as part of a standing order for critical care. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. He denied any CP or SOB. An EKG was repeated at 5 minutes The T-wave is less hyperacute. Maybe there is some spontaneous reperfusion?

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Dr. Smith's ECG Blog

JULY 12, 2020

While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. The cardiac monitor showed sinus rhythm but the automatic blood pressure cuff was not reading.

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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). Crit Care Med.

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Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

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. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria). He reports feeling nauseated with emesis. The Queen was not used in real time. Even the Queen can be wrong.

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Dr. Smith's ECG Blog

OCTOBER 7, 2019

There is an obvious inferior STEMI, but what else? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. This STE is diagnostic of Right Ventricular STEMI (RV MI). In fact, the STE is widespread, mimicking an anterior STEMI. EKG is pictured below: What do you think?

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Dr. Smith's ECG Blog

MAY 5, 2022

Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". It is critically important for all EM and critical care providers to have an intimate understanding of hyperkalemia and its ECG findings. From Ken Grauer ( See below ) — with this Figure adapted from LITFL.

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Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. There is no acute STEMI. This is diagnostic of recent, reperfused STEMI. This is diagnostic of recent, reperfused STEMI. Acute STEMI would have upright T-waves.

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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. Here is the ECG at 25 minutes: Terrible LAD STEMI (+) OMI So a CT scan was done which of course showed a normal aorta.

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Dr. Smith's ECG Blog

DECEMBER 29, 2024

The PMCardio Queen of Hearts app asks you, before giving an interpretation of OMI ("STEMI-Equivalent"), whether the patient's clinical presentation is high risk for OMI. 20 cases with pseudonormalization Case continued The patient was moved to the critical care area, and cardiology was consulted.

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Dr. Smith's ECG Blog

NOVEMBER 23, 2024

It is diagnostic of OMI, but this is SUBACUTE OMI I sent this ECG to my "EKG Nerdz" friends, without any clinical info at all and they answered "OMI" The Queen said: "STEMI-Equivalent with High Confidence:" Notice she sees findings in both normal beats and PVCs. There is STE in V5-6. There are new Q-waves in aVL, V5-6.

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Dr. Smith's ECG Blog

MARCH 8, 2025

Multidisciplinary critical care management of electrical storm. There was indication of parasympathetic overdrive ( the acute inferior STEMI with profound bradycardia and junctional escape ). [link] Jentzer, J. Noseworthy, P. Kashou, A. Chrispin, J., Tisdale, J. & Solomon, M. link] Mostofsky, E., Maclure, M., Sherwood, J.

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