Dr. Smith's ECG Blog

AUGUST 30, 2020

This ECG was texted to me with the message "A 31 year old with Diabetes and HTN complains of bilateral arm tingling and headache." The computer calls it a STEMI. See this case of Type 2 STEMI due to severe hypertension. Here are more Type II STEMI. There is high lateral ST Elevation and inferior reciprocal ST depression.

Diabetes 52

Diabetes Chest Pain Hypertension STEMI 52

Dr. Smith's ECG Blog

AUGUST 19, 2023

Written by Jesse McLaren A 75 year-old patient with diabetes and end stage renal disease was sent to the ED after dialysis for three days of nausea, vomiting, loose stool, lightheadedness and fatigue. They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. RR18 sat 99% HR 90 BP 90/60, afebrile.

Chest Pain 98

Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

OCTOBER 17, 2024

The prehospital and ED computer interpretation was inferior STEMI: There’s normal sinus rhythm, first degree AV block and RBBB, normal axis and normal voltages. The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. Past medical history included diabetes and hypertension.

Chest Pain 73

Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. This ECG is highly concerning for LAD occlusion despite it not showing a STEMI criteria.

Chest Pain 120

Chest Pain STEMI Ultrasound Heart Attack 120

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

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

The overall prevalence of arterial hypertension was 33.2%, hyperlipidemia, 26.9%, smoking, 17.8%, and diabetes, 3.9%. with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. Approximately 48.5%

SCAD 75

SCAD Coronary Artery Bypass Graft Outcomes Myocardial Infarction 75

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

Coronary Artery Disease Journal

NOVEMBER 20, 2023

After propensity-score-matching, primarily adjusting for age, hypertension and diabetes, our data revealed similar accumulated MACE in women and men (5.5% In the unmatched STEMI subgroup, all-cause mortality was significantly higher in females driven by older age (P < 0.001). vs. 3.9%; P = 0.020). vs. 5.2%; P = 0.749).

Stent 52

Stent Stents Outcomes Coronary Artery Disease 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

These elevations meet STEMI criteria ( ≥ 1mm in 2 contiguous leads). While this may be change that is reciprocal to an Acute/Subacute Inferior STEMI, the problem is that LV aneurysm may also manifest with this reciprocal change. In STEMI, they are generally upright and large in proportion to the QRS. This case is tough.

Chest Pain 52

Chest Pain Aneurysm STEMI Document 52

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

The models were mainly constructed using data from individuals diagnosed with ST-segment elevation myocardial infarction (STEMI). The commonly used predictor variables include LVEF, age, Killip classification, diabetes, and various others.

Myocardial Infarction 59

Myocardial Infarction STEMI Article Diabetes 59

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

Written by Jesse McLaren, with edits from Smith A 30 year old with a history of diabetes presented with two days of intermittent chest pain and diaphoresis, which recurred two hours prior to presentation. It was signed off by an emergency physician as “STEMI negative” because it did not meet STEMI criteria.

Chest Pain 52

Chest Pain STEMI Ischemia Stenosis 52

Dr. Smith's ECG Blog

DECEMBER 6, 2022

A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. Had the cardiologists followed NSTEMI or transient STEMI guidelines, which recommend non-urgent cath, the patient could have redeveloped an OMI and had a worse outcome. What do you think?

Chest Pain 52

Chest Pain STEMI Diabetes Circulation 52

Dr. Smith's ECG Blog

OCTOBER 22, 2024

This was sent to me by a French colleague, Olivier Peyronie "Yesterday we received a 62 yo man with diabetes, hypertension and smoker. Unfortunately, the cardiologist waited until the next day to refer the patient for angiography and intervention because patient did not meet criteria for "STEMI"." Time zero: What do you think?

Chest Pain 66

Chest Pain STEMI Myocardial Infarction Angioplasty 66

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Case submitted and written by Mazen El-Baba MD, with edits from Jesse McLaren and edits/comments by Smith and Grauer A 90-year old with a past medical history of atrial fibrillation, type-2 diabetes, hypertension, dyslipidemia, presented with acute onset chest/epigastric pain, nausea, and vomiting. BP was 110 and oxygen saturation was normal.

Ischemia 52

Ischemia STEMI Stenosis Chest Pain 52

The British Journal of Cardiology

APRIL 16, 2024

Comorbidities included dyslipidaemia 515/567 (90.9%), hypertension 460/567 (81.2%), diabetes 346/567 (61%), known prior coronary disease 250/567 (44.2%), and smoking 188/567 (33.1%).

Outcomes 40

Outcomes Cardiogenic Shock Angina STEMI 40

Dr. Smith's ECG Blog

MAY 8, 2023

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. I cannot be anything else.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Pacemaker 52

Dr. Smith's ECG Blog

JUNE 17, 2017

The above is what I thought when I saw this, so I went to the chart and found this history: A type I diabetic aged approximately 35 years old presented with chest pain, nausea, vomiting and diffuse abdominal pain. The possibility of anterior STEMI was not noticed during patient care. pH = 7.17, pCO2 = 24, HCO3 = 8. It was stented.

Chest Pain 52

Chest Pain Myocardial Infarction STEMI Stents 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. New ST elevation diagnostic of STEMI [equation value = 25.3

Chest Pain 52

Chest Pain Thrombosis Myocardial Infarction STEMI 52

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." See far below for data on 24 troponin T in STEMI and NSTEMI, and correlation with infarct size.

Chest Pain 40

Chest Pain STEMI Myocardial Infarction Coronary Artery Disease 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). No ECG was ordered on Day #1.

Chest Pain 120

Chest Pain Blog Hospital Tachycardia 120

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. Breath sounds were clear in all lung fields.

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

Dr. Smith's ECG Blog

FEBRUARY 14, 2020

Written by Pendell Meyers, sent by Anonymous A man in his 50s with history of type 2 diabetes, HTN, and HLD presented with one day of off and on chest / upper abdominal pain. Some patients will not progress (or not as quickly) to obvious STEMI, as in this case. Vitals were within normal limits.

Chest Pain 52

Chest Pain STEMI Anatomy Risk Factors 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Pulse was 115, BP 140/65, and afebrile He was found to have cellulitis and to be in diabetic ketoacidosis, with bicarb of 14, pH of 2.27, glucose of 381, anion gap of 18, and lactate of 2.2 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 118

Chest Pain Ischemia Echocardiogram Myocardial Infarction 118

Dr. Smith's ECG Blog

JANUARY 28, 2018

He has a history of known CAD, diabetes, and dyslipidemia. The STD in V2-V4 is almost certainly reciprocal STD, reciprocal to STEMI in the posterior wall; this is evident because it is maximal in V2-V4, not in V4-V6. Moreover, T-wave inversion in aVL was also found to be 100% sensitive and 86% specific for inferior STEMI.

Pericarditis 52

Pericarditis Ischemia STEMI Chest Pain 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

His medical history includes hypertension, a decade-long battle with diabetes, ischemic heart disease, a coronary bypass graft surgery ten years ago, a diagnosis of congestive heart failure for the last five years, and a prior ICD implantation five years ago. That was also my initial concern. No "baseline" ECG is available for comparison.

Tachycardia 112

Tachycardia Blog Ischemia Heart Failure 112

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

A middle-aged diabetic dialysis patient presented with 24 hours of nausea and vomiting associated with ~6 pound weight loss. It is uncommon in the age of reperfusion therapy, as most STEMI get treated reasonably early, before transmural infarct. Most STEMI peak at over 10 ng/mL; most NonSTEMI at less than 10 ng/mL.

Aneurysm 52

Aneurysm Ischemia Embolism STEMI 52

Dr. Smith's ECG Blog

DECEMBER 29, 2018

Here is a repeat ECG 45 minutes later with persistent chest pain: Obviously progressing into a clear STEMI. Meets formal STEMI criteria in V2-V3. The ECG was interpreted as non-ischemic. The patient was closely monitored. Also notice clearly hyperacute T waves in V2-V4, as well as worsening STD in V5-6 and II, III, aVF.

Chest Pain 52

Chest Pain STEMI Diabetes Hypertension 52

Dr. Smith's ECG Blog

AUGUST 26, 2019

Written by Pendell Meyers A woman in her 70s with diabetes, hypertension, and hyperlipidemia suddenly developed nausea, diaphoresis, and brief syncope while eating at a restaurant. This one likely does meet STEMI criteria in II, III, and aVF. Criteria for a STEMI are definitely not met in ECG #1. Serial troponins were negative.

Chest Pain 52

Chest Pain STEMI Biomarkers Article 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The documentation does not describe any additional details of the history. The following ECG was obtained. ECG 1 What do you think? The ECG shows sinus bradycardia but is otherwise normal.

Angina 120

Angina Plaque Document Stents 120

Dr. Smith's ECG Blog

APRIL 20, 2018

female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chest pain for the past four hours. Given her risk factors (HTN, HLD, ESRD from diabetes) I decided to obtain a broad cardiac workup for the patient: serial ECGs, labs, serial troponins, CXR and bedside cardiac ultrasound.

Chest Pain 40

Chest Pain Ultrasound Risk Factors STEMI 40

EMS 12-Lead

MAY 8, 2022

The attending crews were concerned for SVT with corresponding ischemic hyperacute T waves (HATW) and subsequently activated STEMI pre-hospital. In today’s case the patient is suffering from diabetic ketoacidosis, which facilitates hydrogen ion shift into the cells in exchange for potassium.

ACE Inhibitor 52

ACE Inhibitor Ischemia STEMI Physiology 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Higher troponin correlated with more history of heart failure, diabetes, and hypertension, as well as higher D-dimer, and nearly all inflammatory markers. In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease. Median age was 66.4

Cardiac Arrest 52

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock 52

Dr. Smith's ECG Blog

JULY 1, 2019

Case 2: sent by Dr. James Alva A man in his 50s with diabetes, hypertension, and hyperlipidemia presented to the ED with chest pain and shortness of breath off and on over the past three days, with associated vomiting. There is also much STE in V3-V6, especially V4-V6, that must be considered to be STEMI. Peak troponin was 3.21

Chest Pain 52

Chest Pain Ischemia STEMI Blog 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. This is written by Willy Frick, an amazing cardiology fellow in St. He described it as "10/10" intensity, radiating across his chest from right to left.

Plaque 127

Plaque Angina Blog Stent 127

Dr. Smith's ECG Blog

SEPTEMBER 21, 2022

A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. OMI that are not STEMI can be very subtle and difficult to diagnose even though the findings are very specific. The patient was very agitated and could not hold still.

Chest Pain 52

Chest Pain Blog Ischemia STEMI 52

Dr. Smith's ECG Blog

MAY 1, 2023

edits by Meyers A woman in her 60s with a history of chronic atrial fibrillation on Eliquis, ESRD on hemodialysis, type-II diabetes mellitus, prior CVA, hypertension, and hyperlipidemia presented to the emergency department with multiple complaints after missing dialysis. Is this inferor STEMI? Atrial Flutter with Inferior STEMI?

Atrial Flutter 52

Atrial Flutter Tachycardia Arrhythmia Blog 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia. The pain was still ongoing at arrival. He also noted a bilateral "odd feeling" in his arms. He stated it was similar to prior heart attacks.

Chest Pain 52

Chest Pain Cardiac Arrest Cardiogenic Shock Heart Attack 52