Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? This is the response he got: Interventionist: "No STEMI, no cath. After stabilizing the patient and recording more ECGs, he tried again: Interventionalist: "It isn't a STEMI." It is a STEMI equivalent. We don't know how many though.

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STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

JUNE 18, 2011

This is a 45 yo male who had an inferior STEMI 6 months prior, was found to have severe LAD and left main disease, and was supposed to be set up for CABG a few weeks later, but did not follow up. But it could be anterior STEMI. 40% of anterior STEMI has upward concavity in all of leads V2-V6. is likely anterior STEMI).

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STEMI Pericarditis Hospital Aneurysm 52

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

See these 2 articles Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study Author links open overlay panel [link] 1 Background We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury.

Chest Pain 119

Chest Pain STEMI Myocardial Infarction Electrocardiogram 119

Dr. Smith's ECG Blog

APRIL 6, 2024

In fact, it read: ** **ACUTE MI / STEMI ** ** The physicians caring for the patient activated the cath lab for "STEMI". The interventionalist and cath team came to the hospital, and when the interventionalist saw the ECG, he inquired further and elicited a family history of Brugada syndrome. And it is clearly Brugada phenotype.

Chest Pain 122

Chest Pain STEMI Hospital 122

Open Heart

NOVEMBER 20, 2023

Aims We evaluated the effects of the COVID-19 pandemic on hospital admission and quality of care for acute coronary syndrome. Data on 21 001 patients were included (7057 ST-elevation myocardial infarction (STEMI), 7649 non-ST elevation myocardial infarction (NSTEMI) and 6295 unstable angina).

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COVID-19 Hospital Angina Myocardial Infarction 52

Dr. Smith's ECG Blog

MARCH 31, 2024

The interventional cardiologist then canceled the activation and returned the patient to the ED without doing an angiogram ("Not a STEMI"). I advised that perhaps posterior leads would help to persuade the interventionalist, since the 2022 ACC recommendations include posterior STEMI as a formal STEMI equivalent, but only officially by 0.5

Chest Pain 110

Chest Pain STEMI Ischemia Myocardial Infarction 110

Dr. Smith's ECG Blog

JUNE 17, 2016

Jason was very skeptical of STEMI. This also argues against STEMI. Unfortunately, this option might not be available for pre-hospital tracings ( but it can be done once the patient arrives in the ED for their initial hospital tracing ). He complained of 3 days of diarrhea and abdominal pain. What do you think?

STEMI 52

STEMI Chest Pain Hospital Blog 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He has now implemented the Queen of Hearts in his hospital. The emergency physician asked the advice of Dr. Reiters because of absence of STEMI criteria. This case was sent by Dr. Jean-christophe Reiters, an interventionalist in Belgium. He has been following the blog for 4 years. He wanted to share one of the first cases.

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Hospital STEMI Blog Chest Pain 85

All About Cardiovascular System and Disorders

MAY 26, 2024

Both microvascular resistance reserve and index of microcirculatory resistance were shown to be independent predictors for the composite of all-cause mortality or hospitalization for heart failure [2]. Immediate Microvascular Physiology After Mechanical Coronary Reperfusion of STEMI. J Am Coll Cardiol. 2024 May, 83 (21) 2077–2079.

STEMI 52

STEMI Outcomes Coronary Artery Disease Myocardial Infarction 52

Circulation

NOVEMBER 11, 2024

Background:Little is known about the clinical relevance of interleukin (IL)-6 and the severity of patients with acute ST-elevation myocardial infarction (STEMI). This study examined the possible associations of plasma IL-6 concentrations with TIMI scores in STEMI patients treated with primary percutaneous coronary intervention (PCI).Methods:The

STEMI 40

STEMI Myocardial Infarction Tricuspid Biomarkers 40

Dr. Smith's ECG Blog

OCTOBER 6, 2024

An ECG was recorded immediately at triage and, at this hospital, the Queen of Hearts is routinely used to determine cath lab activation. The Non-STEMI, which was an OMI, was diagnosed much faster with AI on the ECG than with troponin. This patient had the onset of chest pain 24 hours before arrival to the ED.

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Hospital Chest Pain Blog Pulmonary 77

Dr. Smith's ECG Blog

AUGUST 11, 2024

While STEMI negative, the ECG is diagnostic of proximal LAD occlusion. Transient STEMI” are often managed like non-STEMI with delayed angiography, which is very risky. This case is an example of the steps we can all take in daily practice as the paradigm shifts from STEMI to OMI.

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Chest Pain STEMI Bradycardia Article 100

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). We compared patientlevel characteristics of patients who did and did not undergo PCI at each hospital. versus 7.4%,P<0.001), versus 5.1%,P<0.001)

Myocardial Infarction 40

Myocardial Infarction Hospital STEMI Cardiac Arrest 40

HCPLive

APRIL 4, 2025

Patients hospitalized for STEMI achieved similar outcomes with rivaroxaban as warfarin after three months of follow-up in the RIVAWAR trial.

STEMI 52

STEMI Hospital Outcomes 52

Ken Grauer, MD

DECEMBER 15, 2023

About 20 minutes later ( on the way to the hospital ) — the patient's CP resolved, and ECG #1 was recorded. mmm ECG Blog #193 — Reviews the concept of why the term “OMI” ( = O cclusion-based MI ) should replace the more familiar term STEMI — and — reviews the basics on how to predict the " culprit " artery.

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Blog STEMI Ischemia Chest Pain 151

Dr. Smith's ECG Blog

MARCH 14, 2024

The most recent study found a NPV of 100% of triage ECGs labeled ‘normal’ or ‘otherwise normal’ for final hospital diagnosis of ACS, and concluded that avoiding physician interruption would “alleviate interruptions in workflow and improve patient safety.” Cath lab was activated, with door-to-cath time of 118 minutes.

Chest Pain 119

Chest Pain STEMI Outcomes Electrocardiogram 119

Dr. Smith's ECG Blog

MAY 20, 2024

The cardiologist recognized that there were EKG changes, but did not take the patient for emergent catheterization because the EKG was “not meeting criteria for STEMI”. So the patient was admitted to the hospital with no plan for an angiogram. Most STEMI have peak troponin I over 1000 ng/L and most NSTEMI below that level.

Chest Pain 125

Chest Pain Blood Pressure Ischemia STEMI 125

Coronary Artery Disease Journal

MAY 29, 2024

Background Despite advances in percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI), in-hospital mortality remains a concern, highlighting the need for the identification of additional risk factors such as serum iron levels. μmol/L) and a control group (Fe ≥7.8 μmol/L).

Myocardial Infarction 40

Myocardial Infarction Hospital STEMI Risk Factors 40

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

Background The diagnosis of a left ventricular (LV) thrombus in patients with ST-segment elevation myocardial infarction (STEMI) remains challenging. Methods We retrospectively evaluated 337 consecutive STEMI patients. All patients underwent transthoracic echocardiography (TTE) and CMRI during their index hospitalization.

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Myocardial Infarction STEMI Hospital 80

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.

Chest Pain 111

Chest Pain Myocardial Infarction Stents Stent 111

Ken Grauer, MD

JUNE 14, 2024

Prompt cath is therefore advised if the post-ROSC shows an acute STEMI. To Emphasize: The phenomenon of T-QRS-D is not needed in today's case to recognize the acute STEMI. Retrospective questioning of the driver who brought this patient to the hospital revealed that he was having chest pain as the reason for presenting to the ED.

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Blog STEMI Cardiac Arrest Tachycardia 161

Ken Grauer, MD

FEBRUARY 3, 2024

Despite the absence of significant coronary stenosis on her post-arrest cath — the ECG in Figure-1 is clearly diagnostic of an extensive anterolateral STEMI ( presumably from acute LAD [ L eft A nterior D escending ] coronary artery occlusion). The rhythm in ECG #1 is regular and supraventricular at a rate of ~75/minute.

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Blog Cardiac Arrest STEMI Plaque 163

Open Heart

JANUARY 27, 2022

Background Early recognition of ST-segment elevation myocardial infarction (STEMI) is needed for timely cardiac monitoring and reperfusion therapy. The national cardiac (ANZACS-QI) registry and national administrative datasets capture all New Zealand public hospital admission diagnoses and mortality data.

Myocardial Infarction 52

Myocardial Infarction STEMI Hospital 52

Ken Grauer, MD

AUGUST 26, 2023

These tall T waves are associated with flattening ( straightening ) of the ST segment in the inferior leads — with slight S T elevation in leads V2-thru-V6 ( albeit not enough to qualify as a "STEMI" — Akbar et al, StatPearls, 2023 ). About 20 minutes later ( on the way to the hospital ) — the patient's CP resolved, and ECG #1 was recorded.

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Blog Chest Pain STEMI Ischemia 145

Becker's Hospital Review - Cardiology

OCTOBER 8, 2024

The Society of Cardiovascular Angiography and Interventions has published an expert consensus statement on the management of patients with ST-elevation myocardial infarction.

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STEMI Myocardial Infarction 52

Dr. S. Venkatesan MD

MARCH 3, 2025

Is primary PCI superior to thrombolysis in the first hour of STEMI ? No, it is not. I know, most interventional cardiologists cannot accept this fact and would strongly disagree. Still, they know very well there is no clear data to back up their belief. Read ref 1, 2. Reference 1.

Hospital 40

Hospital Angioplasty Myocardial Infarction Thrombolysis 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). In-hospital mortality was directly related to Killip classification (2.3%, 7.3%, 16.3%, 29.2%) with statistical significance.

Myocardial Infarction 52

Myocardial Infarction STEMI Biomarkers Hospital 52

Circulation

NOVEMBER 11, 2024

Patients were categorized as frail if they had a hospital frailty risk score (HFRS) of 5 or higher, and non-frail if their score was below 5. Patients were categorized as frail if they had a hospital frailty risk score (HFRS) of 5 or higher, and non-frail if their score was below 5. 10.82), GI hemorrhage (AOR = 2.03, 95% CI: 1.63-2.53),

Heart Disease 40

Heart Disease Hospital Inpatient Outcomes 40

Frontiers in Cardiovascular Medicine

OCTOBER 7, 2024

BackgroundIn Thailand, access to specific pharmaceuticals and medical devices for ST-elevation myocardial infarction (STEMI) patients is restricted within certain healthcare systems, leading to inequalities in the quality of medical care among different healthcare systems.

Public Health 52

Public Health Myocardial Infarction STEMI Coronary Artery Disease 52

Frontiers in Cardiovascular Medicine

JANUARY 13, 2025

BackgroundThe pharmacoinvasive (PhI) strategy is the standard-of-care for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (pPCI) is unfeasible. Optimal timing for post-fibrinolytic PCI (lysis-PCI) remains elusive.

Myocardial Infarction 52

Myocardial Infarction Outcomes STEMI Hospital 52

Dr. Smith's ECG Blog

AUGUST 19, 2023

This is diagnostic of infero-posterior OMI, but it is falsely negative by STEMI criteria and with falsely negative posterior leads (though they do show mild ST elevation in V4R). They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS.

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Chest Pain STEMI Myocardial Infarction Blog 98

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. This has resulted in an under-representation of STEMI MINOCA patients in the literature. From Gue at al. Circulation. 2017;135(16):1490–3.

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Coronary Angiogram Plaque Thrombosis STEMI 109

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

She presented to an outside hospital after several days of malaise and feeling unwell. 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. At the time of admission, her vital signs were normal. Heart rate was in the 80s.

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Cardiogenic Shock Chest Pain Pericarditis Myocardial Infarction 109

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. The patient had a protracted hospitalization and did not survive.

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Chest Pain STEMI Pulmonary Embolism 73

Dr. Smith's ECG Blog

OCTOBER 15, 2024

A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. The two cases were considered: Patient 1 was recognized by the ED provider and the cardiologist as having resolved “STEMI”. Patient 1 remained in the hospital overnight.

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Chest Pain STEMI Echocardiogram Stents 116

Dr. Smith's ECG Blog

MAY 1, 2016

Inferior STEMI without inferior ST elevation. The development of an inferior-posterior STEMI, from prehospital to hospital Case 6. Is this STEMI? Subtle Inferoposterolateral STEMI Details in every case make it even better, so click on the link!! Chest Pain in a 61 year old male. Inferior Hyperacute T-waves Case 3.

Chest Pain 52

Chest Pain STEMI Angina Hospital 52

Dr. Smith's ECG Blog

AUGUST 3, 2023

Although there are more criteria to consider when looking for OMIs compared to STEMIs, anyone can learn them, and this guide is intended to help accelerate that process! The guide organizes OMIs into categories based on each of the steps outlined by Drs. I’ve accessed this hand OMI Pocket Guide on both my ipad and iphone.

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Blog Myocardial Infarction STEMI Hospital 92