Circulation

NOVEMBER 11, 2024

Background:The computational pressure-fluid dynamics applied to index of microcirculatory resistance, derived from coronary angiography (CPFD-caIMR) is a promising alternative method of IMR to evaluate the prognosis of STEMI patients. All patients with STEMI underwent CPFD-caIMR and MVO assessment.

STEMI 40

STEMI Heart Failure Circulation Hospital 40

Frontiers in Cardiovascular Medicine

JULY 22, 2024

IntroductionIn developing countries, there is a notable scarcity of real-world data on adherence to optimal medical therapy (OMT) and its correlation with major cardiovascular adverse events (MACEs) after ST-elevation myocardial infarction (STEMI). Patients were followed up for 4.5 ResultsWe included 349 patients with a mean age of 58.08

Myocardial Infarction 59

Myocardial Infarction Risk Factors Cardiogenic Shock STEMI 59

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). There is atrial fibrillation.

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Frontiers in Cardiovascular Medicine

MARCH 10, 2024

Background Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. 3.45) and 4.47 (95% CI: 2.54–7.87),

Myocardial Infarction 59

Myocardial Infarction Cardiogenic Shock Article STEMI 59

Dr. Smith's ECG Blog

MAY 20, 2024

Smith comment 2: I frequently see failure to control BP in patients with acute chest pain or acute heart failure. The Queen of Hearts once again diagnoses OMI with high confidence: The ED provider recognized the changes in this EKG and called cardiology for a STAT consult.

Chest Pain 126

Chest Pain Blood Pressure Ischemia STEMI 126

Circulation: Cardiovascular Imaging

MARCH 24, 2025

Major adverse cardiovascular events included cardiovascular death, hospitalization for heart failure, reinfarction, and unplanned revascularization for the target vessel.RESULTS:During a median follow-up of 3.2 MSI was calculated as the ratio of salvageable myocardium to the area at risk. years (interquartile range, 1.64.7

Myocardial Infarction 40

Myocardial Infarction STEMI Thrombolysis Cardiovascular Imaging 40

Frontiers in Cardiovascular Medicine

JANUARY 19, 2025

IntroductionHypoxic liver injury (HLI) and Killip classification are poor prognostic factors in patients with ST-segment elevation myocardial infarction (STEMI). Left ventricular ejection fraction (LVEF) was below 45% in symptomatic, overt heart failure patients (Killip class II, III, and IV).

Myocardial Infarction 52

Myocardial Infarction STEMI Biomarkers Hospital 52

Dr. Smith's ECG Blog

SEPTEMBER 14, 2014

is very specific for STEMI , and there is some evidence, as well as rationale, that a paced rhythm behaves similarly. Here is one case of anterior STEMI in a paced rhythm. Here is a case of lateral STEMI in a paced rhythm. It is out of proportion to the preceding S-wave, with a maximum ratio in leads V3 and V4 of 10/33 = 0.30.

Chest Pain 52

Chest Pain Pacemaker Cardiomyopathy STEMI 52

Circulation: Cardiovascular Interventions

FEBRUARY 20, 2024

NH-IMRangiowas calculated based on standard coronary angiographic views with 3-dimensional-modeling and computational analysis of the coronary flow.RESULTS:Overall, ECC (a composite of cardiovascular death, cardiogenic shock, acute heart failure, life-threatening arrhythmias, resuscitated cardiac arrest, left ventricular thrombus, post-ST-segment–elevation (..)

Myocardial Infarction 40

Myocardial Infarction STEMI Cardiogenic Shock Cardiac Arrest 40

Dr. Smith's ECG Blog

DECEMBER 9, 2023

He has a history of STEMI and heart failure. link] Case continued The conventional algorithm diagnosed STEMI and so did the paramedics. A Coronary angiogram from 8 years prior revealed that he had had an inferior posterior STEMI at the time due to 100% occlusion of the proximal RCA. He had a prehospital ECG.

Aneurysm 115

Aneurysm Chest Pain Echocardiogram STEMI 115

Journal of the American Heart Association

FEBRUARY 19, 2025

BackgroundThere may be variability in willingness to perform percutaneous coronary intervention (PCI) in higherrisk patients who present with STsegmentelevation myocardial infarction (STEMI). There were 178 984 patients from 582 US hospitals presenting with STEMI who were included. versus 7.4%,P<0.001), versus 5.1%,P<0.001)

Myocardial Infarction 40

Myocardial Infarction Hospital STEMI Cardiac Arrest 40

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

The outcomes of interest were all-cause death and major adverse cardiovascular events (MACE), including acute coronary syndrome (ACS), heart failure (HF), need for additional revascularization, target vessel revascularization (TVR), SCAD recurrence, and stroke. Approximately 48.5%

SCAD 75

SCAD Coronary Artery Bypass Graft Outcomes Myocardial Infarction 75

Dr. Smith's ECG Blog

OCTOBER 9, 2018

link] In this paper, in a department in which they state they have only 50 STEMI per year, they looked at only 8 days worth of triage ECGs for a total of 538. They did not find one STEMI on their triage ECGs (no surprise! We at HCMC have 30 walk-in STEMIs per year; the rest come by ambulance. Am J Emerg Med 36(10):1771-1774.

Chest Pain 52

Chest Pain STEMI Cardiac Arrest Blog 52

Journal of Cardiovascular Pharmacology

NOVEMBER 11, 2024

Patients with ST-segment elevation myocardial infarction (STEMI) and complex coronary artery disease (CAD) face a poor prognosis, including increased heart failure (HF) risk. We performed a pooled secondary analysis of 139 patients with STEMI. We performed a pooled secondary analysis of 139 patients with STEMI.

Coronary Artery Disease 40

Coronary Artery Disease Myocardial Infarction STEMI Heart Failure 40

Dr. Smith's ECG Blog

OCTOBER 24, 2018

This is all but diagnostic of STEMI, probably due to wraparound LAD The cath lab was activated. These include: i ) appreciation of how problematic the definition of “acute STEMI” can be; and , ii ) illustration of how dependence on this definition may result in overlooking acute coronary occlusion.

STEMI 40

STEMI Angina Myocardial Infarction Plaque 40

Dr. Smith's ECG Blog

MARCH 22, 2024

This is documented as a STEMI in the clinical notes and in the cath report, but certainly does not meet STEMI criteria and is therefore an NSTEMI by definition. For national registry purposes, this will be incorrectly classified as a STEMI.) Most STEMI have peak cTnI greater than 10.0. Large STEMI are approximately 30-80.

Chest Pain 114

Chest Pain STEMI Bradycardia Ischemia 114

Circulation

NOVEMBER 11, 2024

This study investigates the relationship between baseline 5-HTP levels and the incidence of major adverse cardiovascular events (MACE) in patients who have experienced ST-elevation myocardial infarction (STEMI).Objective:Our Conclusion:Higher 5-HTP levels are independently associated with a reduced risk of MACE in patients after STEMI.

Myocardial Infarction 40

Myocardial Infarction Coronary Artery Bypass Graft STEMI Angina 40

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. Thus VT is very probable. That was also my initial concern.

Tachycardia 112

Tachycardia Blog Ischemia Heart Failure 112

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The "criteria" for posterior STEMI are 0.5 There was a normal creatinine and no evidence of heart failure and no other reason for chronic injury, so it must be acute. Is it STEMI or NonSTEMI? The troponin I returned at 4.1 ng/mL (ULN = 0.030 ng/mL) , diagnostic of myocardial injury. mm STE in one lead. This includes: 1.

Chest Pain 52

Chest Pain STEMI Aortic Pulmonary 52

Dr. Smith's ECG Blog

JUNE 27, 2021

The patient has heart failure as a result of this event. Meyers note: notice in their documentation many of the classic mistakes of the STEMI generation: "Non ST Elevation MI" as their reasoning for why the patient did not merit emergent reperfusion, while simultaneously calling it "emergently" (after 8 hours!!!)

Myocardial Infarction 40

Myocardial Infarction Ischemia STEMI Pulmonary 40

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. No appreciable skin pallor. Is this OMI?

Myocardial Infarction 52

Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 52

Ken Grauer, MD

MAY 20, 2023

NOTE: It's important to correlate ongoing circumstances at the time that a prior tracing was done ( ie, Was the patient stable and asymptomatic — or were they having chest pain, an exacerbation of heart failure, or some other ongoing process at the time the prior ECG was recorded? ).

Blog 145

Blog Chest Pain Ischemia STEMI 145

European Journal of Heart Failure

OCTOBER 30, 2023

CMR, cardiac magnetic resonance; LV, left ventricular; LVEDVi, left ventricular end-diastolic volume index; LVEF, left ventricular ejection fraction; LVESVi, left ventricular end-systolic volume index; MI, myocardial infarction; pPCI, primary percutaneous coronary intervention; SE, standard error; STEMI, ST-elevation myocardial infarction.

Myocardial Infarction 40

Myocardial Infarction STEMI Angioplasty Research 40

Dr. Smith's ECG Blog

JANUARY 9, 2023

50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. The ECG easily meets STEMI criteria in all leads V2-V6, as well. He was transitioned to oral heart failure medications and discharged home slightly over one week after presentation.

Chest Pain 52

Chest Pain Aneurysm STEMI Thrombosis 52

Dr. Smith's ECG Blog

JUNE 11, 2021

The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Accordingly, in the algorithm by Cai et al for patients with LBBB and ischemic symptoms ( See below ) — the first indication for PCI is clinical: patients with hemodynamic instability or acute heart failure.

Chest Pain 52

Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

EMS 12-Lead

MAY 20, 2022

This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. When OMI is captured in this early phase, there exists the highest amount of salvageable myocardium and least likelihood of heart failure at hospital discharge. Smith comment : V5 and V6 are excessively discordant!!!!

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

BoardVitals - Cardiovascular

JANUARY 18, 2021

Explanation: The EKG illustrates an inferior STEMI. The history of failure to revascularize his right coronary artery followed by acute onset heart failure 48 hours after presentation, as well his examination is most consistent with acute onset mitral regurgitation, secondary to papillary muscle rupture.

Bicuspid/Mitral 52

Bicuspid/Mitral Atrial Fibrillation Chest Pain STEMI 52

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. Then, three minutes later… Crews activated STEMI as she deteriorated into PEA arrest. A finger-stick glucose resulted 551 mg/dL, and the following ECG was recorded.

ACE Inhibitor 52

ACE Inhibitor Ischemia STEMI Physiology 52

Dr. Smith's ECG Blog

AUGUST 6, 2024

It definitely does not fulfill STEMI criteria, and I would argue that it would not lead to cath lab activation in most centers. As a result — the heart rate of ~115/minute in ECG #1 is a worrisome finding. It suggests a more extensive MI, potentially with resultant heart failure. The ECG shows ST depression in lead V3.

Chest Pain 104

Chest Pain Ischemia Pericarditis Tachycardia 104

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

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. Look at the aortic outflow tract. What do you see? Answer below in the still shot.

Ischemia 40

Ischemia Cardiogenic Shock Aortic Stenosis 40

Dr. Smith's ECG Blog

DECEMBER 27, 2018

But lead V2 has a worrisome amount of ST elevation, and in a chest pain patient, I would be worried about STEMI. My subjective interpretation, and that of Pierre's, is of LVH with secondary repolarization abnormalities, including pseudoSTEMI ST elevation in V1-V3. The Ratios of STE to S-wave: V1: 2.5/16

Chest Pain 40

Chest Pain Hypertension STEMI Heart Disease 40

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

100% occluded RCA with TIMI 0 flow Post drug-eluting stent placement with TIMI 3 flow While in the cath lab, she transiently developed complete heart block and became hypotensive requiring transvenous pacemaker placement and transient pressors. 3) STEMI criteria failed to identify this acute coronary occlusion, like many others.

Chest Pain 52

Chest Pain Critical Care Article Pacemaker 52

Dr. Smith's ECG Blog

MARCH 2, 2019

Does this patient have hypertension and/or heart failure that has worsened? Clinically it would be important to find out WHAT HAS HAPPENED in the interim between the time that ECG #2 and ECG #1 were done. This might be a common scenario given this patients demographics and his underlying disease ).

Sickle Cell Disease 52

Sickle Cell Disease Ischemia Dysrhythmia Chest Pain 52

Frontiers in Cardiovascular Medicine

JANUARY 22, 2024

Background Women are more likely to develop heart failure (HF) after myocardial infarction. Methods The patients with PPCI-treated anterior STEMI, from the CIRCUS study cohort, were followed up for 1 year and HF events were recorded. However, diagnosis and reperfusion are often delayed. vs. 4.1%, p  = 0.005).

Myocardial Infarction 64

Myocardial Infarction Heart Failure STEMI Hypertension 64

Dr. Smith's ECG Blog

OCTOBER 13, 2023

There is worrisome T-wave inversion in inferior leads as well, which is another clue to LAD Occlusion In fact, this ECG meets STEMI criteria!! Why does the conventional algorithm not diagnose STEMI? Transient STEMI, serial ECGs prehospital to hospital, all troponins negative (less than 0.04 Learning Points: 1.

Chest Pain 116

Chest Pain STEMI Cardiac Arrest Myocardial Infarction 116

Dr. Smith's ECG Blog

MARCH 19, 2025

Heres the Queen of Hearts interpretation, drawing attention especially to III and aVL: This patient does indeed need emergent intervention. STEMI criteria are only 43% sensitive for OMI. They end up with high mortality and needless heart failure. Beware confusing the diagnosis of posterior STEMI by using posterior leads.

Chest Pain 116

Chest Pain STEMI Stent Stents 116