Hospital Pacemaker STEMI 
Dr. Smith's ECG Blog
MARCH 19, 2024
This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System. The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB.
Dr. Smith's ECG Blog
SEPTEMBER 14, 2014
He presented with chest pain, not relieved by nitro, pain reproducible on exam and centered around the pacemaker insertion site. 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.
Dr. Smith's ECG Blog
JULY 21, 2024
The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker. The below ECG was recorded.
Dr. Smith's ECG Blog
JANUARY 19, 2020
There is STE in III and aVF which does not meet STEMI criteria due to insufficient STE in lead aVF. The interventionalists insisted that the ECGs did not meet STEMI criteria and cancelled the activation, stating that they would consider urgent cath after further stabilization. This is an obvious inferoposterior OMI.
Dr. Smith's ECG Blog
JANUARY 1, 2024
The patient was promptly admitted to the hospital for further evaluation. Again, see Ken's discussion below) Discussion continued The absence of pace spikes suggests this is not a pacemaker/ICD-related rhythm in this patient with an ICD. An initial electrocardiogram (ECG) is provided below. What do you think? What is the rhythm?
EMS 12-Lead
JUNE 20, 2022
According to the EMS narrative, this patient initially refused hospital transport and advised that he would seek evaluation at a later time with his personal physician. A prehospital STEMI activation was transmitted to the closest PCI center, and 324mg ASA was administered. It’s important to stress the presence of a normal QRS (i.e.,
Dr. Smith's ECG Blog
APRIL 8, 2022
There is clearly sufficient STE for STEMI criteria in leads V2 and aVL, but lead I has less than 1.0 mm of STE - thus, technically this ECG does not meet STEMI criteria, although it is a quite obvious OMI. This ECG was immediatel y discussed with the on-call cardiologist who said the ECG was "concerning but not a STEMI."
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