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 Stent 116

Frontiers in Cardiovascular Medicine

JANUARY 15, 2024

with ST elevated myocardial infarction (STEMI), 3.41% with unstable angina, 0.56% with stable angina, and 0.11% were diagnosed with various types of arrhythmias. SCAD-PCI revascularization frequently required three or more stents and had residual areas of dissection. Approximately 48.5% and 1.3%, respectively.

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SCAD Coronary Artery Bypass Graft Outcomes Myocardial Infarction 75

Dr. Smith's ECG Blog

APRIL 22, 2024

Patient still not having chest pain however this is more concerning for OMI/STEMI. Wellens' syndrome is a syndrome of Transient OMI (old terminology would be transient STEMI). As far as I can tell, there is only one randomized trial of immediate vs. delayed intervention for transient STEMI. Labs ordered but not yet drawn.

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Chest Pain Myocardial Infarction Anatomy Angina 118

The British Journal of Cardiology

APRIL 16, 2024

Intra-procedural data included access route, coronary anatomy, lesion complexity, number of stents deployed, door-to-balloon time for primary PCI, and any intra-procedural complications. and the average number of stents 2.6. The radial approach was used in 544/567 (95.94%), the average SYNTAX score was 34.8 ± 9.6,

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Outcomes Cardiogenic Shock Angina STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

These elevations meet STEMI criteria ( ≥ 1mm in 2 contiguous leads). While this may be change that is reciprocal to an Acute/Subacute Inferior STEMI, the problem is that LV aneurysm may also manifest with this reciprocal change. In STEMI, they are generally upright and large in proportion to the QRS. This case is tough.

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Chest Pain Aneurysm STEMI Document 52

Ken Grauer, MD

OCTOBER 25, 2024

P.S.: Cardiac cath was performed — and showed a distal LA D "culprit" lesion that was successfully stented. It may look identical t o the ST-T wave appearance seen after a STEMI with marked troponin elevation, that has now reperfused ( be this reperfusion spontaneous — or by treatment with PCI or thrombolytics ).

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Blog Chest Pain STEMI Cardiogenic Shock 95

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

He was admitted to the hospital for evaluation of these symptoms — but no ECG was done at that time. At 2111, the troponin I peaked at 12.252 ng/mL (this is in the range of STEMI patients, quite high). RAO Caudal View Post PCI This is the RAO Caudal view after thrombectomy and stent placement.

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Chest Pain Blog Hospital Tachycardia 120

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

Written by Pendell Meyers, edits by Steve Smith A man in his 60s with history of hypertension and MI 10 years ago, with PCI, presented to an outside hospital complaining of chest pain that started while mowing the lawn. There is a very small amount of STE in some of the anterior, lateral, and inferior leads which do NOT meet STEMI criteria.

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Chest Pain STEMI Cardiac Arrest Aneurysm 52

Dr. Smith's ECG Blog

JULY 23, 2024

Another ECG was recorded while awaiting the cath team: Now there is STEMI Let's look at that first (prehospital ECG) again: Very subtle! It was opened and stented. This was a weekend late evening, and so it took time the cath team to get in to the hospital. Peak trop was 7000 ng/L (since the intervention was so fast)!!

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Chest Pain Critical Care STEMI Stent 115

Dr. Smith's ECG Blog

OCTOBER 22, 2024

V5-6, is 97% specific for OMI! ) "The patient was transferred to cardiology at the referral hospital (we don't have cardiology in our hospital)." Unfortunately, the cardiologist waited until the next day to refer the patient for angiography and intervention because patient did not meet criteria for "STEMI"."

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Chest Pain STEMI Myocardial Infarction Angioplasty 66

EMS 12-Lead

AUGUST 14, 2022

However, upon entry into the respective hospital campus, the patient experienced restoration of pain and displayed an uncomfortable grimace. One stent was deployed with restorative TIMI-0 flow. it has been subsequently deemed a STEMI-equivalent. it has been subsequently deemed a STEMI-equivalent.

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STEMI Sudden Cardiac Death Thrombosis Thrombolysis 52

Circulation

NOVEMBER 11, 2024

Data was collected from patients and their medical records during hospital stay using a structured data collection form. Types of ACS include stable angina 5.3% (n=8), unstable angina 24% (n=36), NSTEMI 28.7% (n=43), and STEMI 24% (n=36). All patients had interventional PCI with balloon and stent insertion.

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Angina Coronary Artery Disease Biomarkers Atherosclerosis 40

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The "criteria" for posterior STEMI are 0.5 Is it STEMI or NonSTEMI? What do you want to do now, considering you will need to awaken the hospital's only catheterization team, which must be alert for the next long day in the cath lab? The troponin I returned at 4.1 ng/mL (ULN = 0.030 ng/mL) , diagnostic of myocardial injury.

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Chest Pain STEMI Aortic Myocardial Infarction 52

Dr. Smith's ECG Blog

JUNE 12, 2017

This was sent by : Jacob Smith, DO Emergency Medicine Resident Ohio Health Doctors Hospital Emergency Residency Christopher Lloyd, DO, FACEP Director of Clinical Education, USACS Midwest Case A 30 year old patient presents to triage with chest pain. This is diagnostic of inferior MI, though does not meet millimeter criteria for "STEMI."

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Chest Pain STEMI Myocardial Infarction Electrocardiogram 52

Dr. Smith's ECG Blog

AUGUST 6, 2024

Despite active CP — cath lab activation was deferred and this patient was transported to a local hospital without PCI capability. It definitely does not fulfill STEMI criteria, and I would argue that it would not lead to cath lab activation in most centers. Patient #1 in today's post did not get expert ECG interpretation.

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Chest Pain Ischemia Pericarditis Tachycardia 104

Dr. S. Venkatesan MD

JUNE 26, 2024

Wuhan Asia Heart Hospital, Wuhan, China Did you guess the diagnosis correctly? Final message Coronary arterial anomaly is a less discussed topic nowadays, unless & until, it intrudes an interventional cardiologist in his daily routine life, of delivering stents. We know, how adverse is the outcome of Left main STEMI.

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Coronary Angiogram Cardiothoracic Anatomy Atherosclerosis 52

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

He was treated for infection and DKA and admission to hospital was planned. 20% of cases that everyone would call a STEMI have a competely open artery by the time of angiogram 60-90 minutes later. While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain.

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Chest Pain Ischemia Echocardiogram Myocardial Infarction 119

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. Here is the LAD after stent placement.

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STEMI Stent Stents Myocardial Infarction 52

Dr. Smith's ECG Blog

JULY 19, 2019

This morphology can be cause by or associated with cocaine: A Patient with Cocaine Chest Pain and Prehospital Computer interpretation of STEMI This is OMI of the anterior, lateral, and inferior walls until proven otherwise. But it does not meet STEMI criteria and it was not initially recognized. The cath lab was now activated.

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Chest Pain STEMI Aneurysm Pericarditis 52

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?

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Myocardial Infarction STEMI Coronary Angiogram Coronary Artery Disease 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. Similarly, STEMI guidelines call for urgent angiography for refractory ischemia or electrical/hemodynamic instability, regardless of ECG findings. So the RCA was stented. Vitals were HR 58 BP 167/70 R20 sat 96%.

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Chest Pain Cardiac Arrest Ischemia Cardiogenic Shock 52

Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

It was opened and stented. Important Learning Point: "STEMI" is defined by millimeter criteria (1 mm in limb leads), which this does not meet. Therefore it is not a STEMI. But what we truly care about is coronary occlusion, for which STEMI is just a surrogate that is only about 75% sensitive for occlusion. RCA: dominant.

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Ischemia Chest Pain STEMI Stenosis 40

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. He did, found the true culprit, and went back in to stent it. Comment by KEN GRAUER, MD ( 7/11/2018 ): = Insightful blog post by Dr. Smith regarding ECG criteria for recognizing acute RV involvement in patients with inferior STEMI.

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Chest Pain STEMI Ischemia Blog 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI. All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery?

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Myocardial Infarction Ischemia STEMI Cardiogenic Shock 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. The additional ST Elevation in V1 is not usually seen with diffuse subendocardial ischemia, and suggests that something else, like STEMI from LAD occlusion, could be present. It was stented. If you want to understand aVR, read this.]

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Cardiac Arrest Ischemia Defibrillator Electrocardiogram 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. A mid-LAD culprit lesion was identified and stented.

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Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

He had been seen several weeks ago at an outside hospital for a similar issue and had been discharged home, presumably after unremarkable workup. He was successfully treated with one drug eluting stent. He was ultimately discharged after a brief, uncomplicated hospital course. Occurred while driving to a doctor’s appointment.

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Chest Pain Ultrasound STEMI Myocardial Infarction 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

There is an obvious inferior STEMI, but what else? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. This STE is diagnostic of Right Ventricular STEMI (RV MI). In fact, the STE is widespread, mimicking an anterior STEMI. He was successfully stented.

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Bradycardia Cardiogenic Shock STEMI Ischemia 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

These kinds of cases were excluded from the study as obvious anterior STEMI. --QTc Case 1 Acute anterior STEMI from LAD occlusion, or Benign Early Repolarization (BER)? Appropriately, the physicians repeated the ECG 20 minutes later and it was diagnostic of anterior STEMI. QTc is the computer measurement. 100% LAD occlusion.

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Chest Pain STEMI Bradycardia Stenosis 52

Dr. Smith's ECG Blog

OCTOBER 23, 2022

EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 She was having a transient STEMI, briefly. It did not progress to full STEMI with loss of the anterior wall, as in this case. It was stented. She called 911. Learning Points : 1. See this case.

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STEMI Chest Pain Hospital Risk Factors 40

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 52

Myocardial Infarction Pericarditis STEMI Angina 52

EMS 12-Lead

APRIL 2, 2022

He reported a history of ischemic cardiomyopathy with coronary stent placement approximately 10 years prior, but could not recall the specific artery involved. He requested transport to the hospital out of an abundance of caution, and all subsequent serial ECG’s showed no changes from Figure 1-2, shown above. Attached is the first ECG.

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Myocardial Infarction Stent Stents STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

In the context of the abnormal ST elevation we see in leads III and aVF I interpreted this mirror-image J-point depression as a reciprocal change in this LBBB patient whose ECG is diagnostic of an acute inferior STEMI. The Case Continues: The initial ECG was transmitted to the ED physician at the hospital.

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Chest Pain STEMI Blog Myocardial Infarction 52

Dr. Smith's ECG Blog

SEPTEMBER 22, 2019

There is STE that does not meet STEMI criteria in V1-V6. Troponin profile The patient underwent angiography and had a 90% thrombotic proximal LAD lesion that was stented. I focus my attention on the first 2 ECGs, both of which were done prior to arrival in the hospital. Precordial leads: What do you think?

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Chest Pain Ischemia STEMI Stent 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

His initial cTnI at the receiving hospital was 27 ng/mL, and no further troponins were measured thereafter. Slow TIMI 2 initially with brisk flow status post percutaneous coronary intervention with 18mm drug-eluting stent. The patient’s ECG on arrival at the emergency department is shown below. To our knowledge, the patient did well.

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Chest Pain Pulmonary ACE Inhibitor Pacemaker 52

Dr. Smith's ECG Blog

JULY 31, 2018

Post by Smith, with short article by Angie Lobo ( [link] ), a third year intermal medicine resident at Abbott Northwestern Hospital Case A 30-something woman with no past history, who is very fit and athletic, presented with 1.5 It is equivalent to a transient STEMI. The lesion was stented. hours of substernal chest pressure.

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SCAD Chest Pain Myocardial Infarction Ischemia 52

Dr. Smith's ECG Blog

FEBRUARY 6, 2023

Admitted to the hospital service for further evaluation and management." Diagnosis: Acute non-ST segment elevation MI (Non-STEMI, or NSTEMI) Second troponin returned at around 0200: 15,894 ng/L 0245 (unclear if ongoing pain or not) Inferoposterior (and lateral V5-6) reperfusion findings. No further ECG were ever recorded.

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Chest Pain Physiology Blog Stent 52