Embolism, STEMI and Stent - Cardiovascular Update

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 Stent

See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Bi-phasic scan showed no dissection or pulmonary embolism. The lesion was successfully stented. Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. --In summary, some subtle findings which do not fit into a pattern, therefore may be nonspecific ECG changes which are encountered everyday. doi: 10.5543/tkda.2021.21026.

STEMI

STEMI Chest Pain Myocardial Infarction Electrocardiogram

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

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

Early repol or anterior OMI?

Dr. Smith's ECG Blog

MAY 13, 2024

This ECG is highly concerning for LAD occlusion despite it not showing a STEMI criteria. You can find the variables used to calculate the value on MD calc here: [link] Utilizing Dr. Smith’s Subtle Anterior STEMI Calculator (4-Variable), the value is greater than 18.2 The culprit mid LAD lesion was stented.

Chest Pain

Chest Pain STEMI Ultrasound Heart Attack

Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion

Dr. Smith's ECG Blog

DECEMBER 17, 2011

There is inferior STEMI. He took another look and realized that the culprit was indeed in the proximal RCA and that the thrombus had embolized distally. And so he put the stent in the proximal RCA. See down below for explanation if you don't want to watch the video. But there is also ST elevation in leads V1 and V2.

Chest Pain

Chest Pain Embolism STEMI Stents

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

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The "criteria" for posterior STEMI are 0.5 Is it STEMI or NonSTEMI? The patient had been on a long drive, suggesting possible pulmonary embolism (this was unlikely given absence of tachyardia, hypoxia, or any other feature of PE), so we sent a d dimer. The troponin I returned at 4.1 mm STE in one lead. This includes: 1.

Chest Pain

Chest Pain STEMI Aortic Myocardial Infarction

Nausea and Vomiting. This ECG is loaded with information.

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

It was opened and stented. It is uncommon in the age of reperfusion therapy, as most STEMI get treated reasonably early, before transmural infarct. LV aneurysm puts them at risk for a mural thrombus, which puts them at risk for embolism, especially embolic stroke. Patient course The first troponin returned at 200 ng/mL!!

Aneurysm

Aneurysm Ischemia Embolism STEMI

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The commonest causes of MINOCA include: atherosclerotic causes such as plaque rupture or erosion with spontaneous thrombolysis, and non-atherosclerotic causes such as coronary vasospasm (sometimes called variant angina or Prinzmetal's angina), coronary embolism or thrombosis, possibly microvascular dysfunction.

Plaque

Plaque Angina Blog Stents

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

Later, she developed chest pain again, and had this ECG recorded: Obvious Anterior OMI that is also a STEMI Coronary angiogram- --Right dominant coronary artery system --The left main artery was normal in appearance and free of obstructive disease. --The Thus, Wellens' syndrome should be thought of as a transient OMI or transient STEMI.

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. However, by the time of the angiogram it had embolized distally, and had only done so after the right sided ECG was recorded. He did, found the true culprit, and went back in to stent it. But which myocardial walls are affected?

Chest Pain

Chest Pain STEMI Ischemia Blog

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

Dr. Smith's ECG Blog

MARCH 11, 2016

It was treated with and dual "kissing balloons" and drug eluting stents. Here is the post stent ECG: There is greater than 50% resolution of ST elevation (all but diagnostic of successful reperfusion) and Terminal T-wave inversion (also highly suggestive of successful reperfusion). TIMI flow is 0. Door to balloon time was 51 minutes.

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

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

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

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. Also note that LAD does not extensively wrap-around apex and supply inferior wall. Aslanger as one of the co-authors ).

Chest Pain

Chest Pain Myocardial Infarction Blog Pericarditis

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

Dr. Smith's ECG Blog

FEBRUARY 16, 2025

The emergency medicine physician documented, "His initial EKG is riddled with artifact and difficult to interpret but does not look like a STEMI." The ECG remains positive for STEMI by GE. The true AV groove LCx was "jailed" by the stent and appears occluded in the post PCI image. The emergency physician consulted cardiology.

STEMI

STEMI Pericarditis Chest Pain Echocardiogram

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

Dr. Smith's ECG Blog

MARCH 1, 2025

He reports this was similar to how he felt when he had his heart attack 4 years prior, now s/p 4 stents. 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 NSTEMI-OMI").

Chest Pain

Chest Pain STEMI Stents Stent

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

Dr. Smith's ECG Blog

MARCH 8, 2025

After stent deployment, we often see improvement in the ST-T within seconds or minutes. Third, a slow motion segment showing delayed, brisk filling of the PDA due to dislodgment of a thrombus from contrast injection and distal embolization. Here is the final angiogram following placement of a stent in the ostial RCA.

Cardiomyopathy

Cardiomyopathy Myocardial Infarction Defibrillator Bradycardia

What can you find with continuous ST monitoring in the ED?

Dr. Smith's ECG Blog

DECEMBER 3, 2024

His initial high sensitivity troponin I returned at 1300 ng/L and given that his cardiac workup was otherwise unremarkable, a CT was obtained to evaluate for pulmonary embolism and aortic aneurysm or dissection but this too was unrevealing. Another EKG was also obtained. ECG at time 82 minutes: What do you think?

Catheterization Laboratory

Catheterization Laboratory STEMI Blog Ischemia

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. First obtuse marginal also had an 80% stenosis and was stented. Pt received 324 ASA and 2 sprays of nitro with improvement. Cath lab was activated by EMS and transported emergent."

STEMI

STEMI Chest Pain Myocardial Infarction Aneurysm

Interventional thrombus modification in STEMI

See OMI vs. STEMI philosophy in action

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?

Webinars

Early repol or anterior OMI?

Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion

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

Nausea and Vomiting. This ECG is loaded with information.

Concerning EKG with a Non-obstructive angiogram. What happened?

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?

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

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

What factor determines final diagnosis of STEMI vs. NSTEMI? Is it ST Elevation? Occlusion? or Something else? What?

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

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

What can you find with continuous ST monitoring in the ED?

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

Stay Connected