Embolism, Myocardial Infarction and STEMI

Pericarditis, or Anterior STEMI? The QRS proves it.

Dr. Smith's ECG Blog

AUGUST 24, 2012

This ECG is diagnostic of anterior STEMI. This is a good sign for myocardial infarction and does not happen in pericarditis. The distal inferior apical LAD was cut off by distal embolization from LAD culprit. The QRS is at least as important as the ST segment in diagnosing STEMI It has been constant since then.

Pericarditis

Pericarditis STEMI Chest Pain Myocardial Infarction

Interventional thrombus modification in STEMI

Nature Reviews - Cardiology

APRIL 1, 2024

Nature Reviews Cardiology, Published online: 02 April 2024; doi:10.1038/s41569-024-01020-2 In ST-segment elevation myocardial infarction, the role of interventional modification of thrombi in the coronary arteries before stenting is controversial.

STEMI

STEMI Myocardial Infarction Embolism Stents

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

associated typical Myocardial Infarction therapies such as statins and ACE inhibitors with significantly decreased 1 year mortality in MINOCA patients, which suggests that they do indeed have a similar pathophysiology to MI patients with obstructive coronary disease. MINOCA I do not have the bandwidth here to write a review of MINOCA.

Coronary Angiogram

Coronary Angiogram Plaque Thrombosis STEMI

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A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Dr. Smith's ECG Blog

MAY 23, 2023

Notice on the right side of the image how the algorithm correctly measures STE sufficient in V1 and V2 to meet STEMI criteria in a man older than age 40. As most would agree, this ECG shows highly specific findings of anterolateral OMI, even with STEMI criteria in this case. Thus, this is obvious STEMI(+) OMI until proven otherwise.

Chest Pain

Chest Pain STEMI Blog Stents

Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.

Dr. Smith's ECG Blog

DECEMBER 14, 2016

ng/mL (ULN = 0.030 ng/mL) , diagnostic of myocardial injury. The "criteria" for posterior STEMI are 0.5 Acute myocardial injury: Is it myocardial infarction, or perhaps myocarditis? Is it STEMI or NonSTEMI? The troponin I returned at 4.1 mm STE in one lead. There is zero ST Elevation. This includes: 1.

Chest Pain

Chest Pain STEMI Aortic Myocardial Infarction

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

MAY 19, 2020

This is a troponin I level that is almost exclusively seen in STEMI. In this case, profound shock for 1 hour would result in the same degree of infarction. A followup ECG was recorded 2 days later: No definite evidence of infarction. So this is either a case of MINOCA, or a case of Type II STEMI. Troponin I rose to 44.1

Defibrillator

Defibrillator Circulation Plaque Cardiac Arrest

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Such cases are classified as MINOCA (Myocardial Infarction with Non-Obstructed Coronary Arteries). Transient and partial thrombosis at the site of a non-obstructive plaque with subsequent spontaneous fibrinolysis and distal embolization may be one of the mechanisms responsible for the occurrence of MINOCA. Learning Points: 1.

Plaque

Plaque Chest Pain Thrombosis Stenosis

Sometimes even ST Elevation meeting criteria is not enough to be convincing

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

The ECG in ER is shown below: ECG is still diagnostic but we are watching the natural course of myocardial infarction here. You may see a filling defect in distal LAD, most probably due to an embolization from proximal lesion. The lesion was successfully stented, but it was unfortunately done after a significant myocardial loss.

Chest Pain

Chest Pain Myocardial Infarction Blog Pericarditis

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

MAY 10, 2023

ng/mL This single initial troponin at this level, in the context of chest pain, is high enough to be diagnostic of acute myocardial infarction. If there are T-wave inversions and elevated trops in the context of persistent pain, think of other pathologies such as pulmonary embolism. Her initial cTnI returned at 0.25

Coronary Angiogram

Coronary Angiogram Chest Pain Stenosis STEMI

Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

Dr. Smith's ECG Blog

JULY 11, 2018

This is of course diagnostic of an acute coronary occlusion MI (OMI) that also meets STEMI criteria. But which myocardial walls are affected? However, by the time of the angiogram it had embolized distally, and had only done so after the right sided ECG was recorded. Can you tell from this ECG? The proposed mechanism is complex.

Chest Pain

Chest Pain STEMI Ischemia Blog

Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?

Dr. Smith's ECG Blog

JANUARY 17, 2024

The limb leads have been removed because there was no ST elevation in those leads, the QRS complexes have been obscured because this is irrelevant to STEMI criteria, and red lines have been added to measure ST segment elevation. But STEMI criteria ignore all this and look at ST segments in isolation.

Chest Pain

Chest Pain STEMI Myocardial Infarction Blog

See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction. Bi-phasic scan showed no dissection or pulmonary embolism. Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. Turk Kardiyol Dern Ars. 2021.21026.

STEMI

STEMI Chest Pain Myocardial Infarction Electrocardiogram

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. In normal times, the most common use of cTni is in diagnosing, or ruling out, acute myocardial infarction (AMI, a subcategory of acute myocardial injury.

Cardiac Arrest

Cardiac Arrest COVID-19 Myocardial Infarction Cardiogenic Shock

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

Appearance of abnormal Q waves early in the course of acute myocardial infarction: implications for efficacy of thrombolytic therapy. Both of these are very suggestive of " No-Reflow ," or poor microvascular reperfusion due to downstream embolization of microscopic platelet-fibrin aggregates. Raitt MH, et al. LV Thrombus , 1.5

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

Chest pain and this ECG. Angiogram totally normal. Is this myocarditis?

Dr. Smith's ECG Blog

APRIL 13, 2025

They recorded this ECG: Obvious inferior STEMI/OMI What else? Here it is annotated in red: Our extremely smart radiologist, Gopal Punjabi , assures me that this finding can only be due to myocardial infarction, not myocarditis. The patient was found to have an embolic source. Embolism with lysis. He called 911.

Chest Pain

Chest Pain Embolism STEMI Plaque

Pay now (in the evening) or pay later with interest (in the middle of the night).

Dr. Smith's ECG Blog

MARCH 1, 2025

Note: the 2022 ACC Expert consensus Chest pain guidelines state that "posterior STEMI-Equivalent" is a sign of acute coronary occlusion. 2/3 of STEMI have a peak 4th generation troponin I greater than 10.0 Comment: The first ECG is diagnostic of OMI that does not meet STEMI criteria. NSTEMI-OMI").

Chest Pain

Chest Pain STEMI Stents Stent

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Dr. Smith's ECG Blog

APRIL 9, 2025

The paramedics diagnosis was "Possible Anterolateral STEMI." LAD: type III-IV vessel with a proximal thrombotic or embolic occlusion (TIMI 0 flow). More proof that a huge STEMI may have normal or near normal initial troponin. Taken together, these findings suggest an ongoing extensive antero-lateral STEMI. Angiogram: 2.

Defibrillator

Defibrillator Cardiac Arrest Myocardial Infarction STEMI

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

Dr. Smith's ECG Blog

OCTOBER 27, 2024

The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". No pulmonary embolism is identified. Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients. Pain was decreased to 2/10.

STEMI

STEMI Chest Pain Myocardial Infarction Aneurysm

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

Dr. Smith's ECG Blog

MARCH 8, 2025

Third, a slow motion segment showing delayed, brisk filling of the PDA due to dislodgment of a thrombus from contrast injection and distal embolization. A distal RCA lesion ( blue arrow ), Delayed brisk filling of an initially occluded PDA due to a thrombus dislodged during injection which embolized distally. SanzRuiz, R., Tang, Z.,

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

Cardiovascular Update

Pericarditis, or Anterior STEMI? The QRS proves it.

Interventional thrombus modification in STEMI

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

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A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.

1 hour of CPR, then ECMO circulation, then successful defibrillation.

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Sometimes even ST Elevation meeting criteria is not enough to be convincing

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

Is there a Right Ventricular MI in addition to Infero-postero-lateral MI?

Two patients with chest pain, with QRS obscured: which was STEMI positive, and which had Occlusion MI?

See OMI vs. STEMI philosophy in action

Extreme shock and cardiac arrest in COVID patient

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Chest pain and this ECG. Angiogram totally normal. Is this myocarditis?

Pay now (in the evening) or pay later with interest (in the middle of the night).

Anterior OMI with RBBB has VF x 3: how to prevent further episodes of VF?

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

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

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