ICU Ischemia STEMI 
Dr. Smith's ECG Blog
OCTOBER 26, 2011
Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. The LAD has reperfused early. This was recorded 2.5
Dr. Smith's ECG Blog
OCTOBER 25, 2023
A prior ECG was available for comparison: Normal One might be tempted to interpret the ST depression as ischemia, but as Smith says, "when the QT is impossibly long, think of hypokalemia and a U-wave rather than T-wave." The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course.
Dr. Smith's ECG Blog
MARCH 6, 2019
This is technically a STEMI, with 1.5 However, I think many practitioners might not see this as a clear STEMI, and would instead call this "borderline." They collected several repeat ECGs at the outside hospital before transport: None of these three ECGs meet STEMI criteria. This ECG was recorded on arrival: What do you think?
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. Thankfully, the patient experienced an uncomplicated ICU stay and subsequently made a full recovery. Then, three minutes later… Crews activated STEMI as she deteriorated into PEA arrest.
Dr. Smith's ECG Blog
JANUARY 6, 2023
I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. Lupu L, et al. mg/dL, K 3.5 Abstract 556.
Dr. Smith's ECG Blog
MARCH 11, 2019
The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW." The patient was managed in the ICU and had serial troponins. Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI. First was 2.9
Dr. Smith's ECG Blog
SEPTEMBER 29, 2018
Normally, concavity in ST segments suggests absence of anterior ischemia (though concavity by itself is not reassuring - see this study ). Fortunately, he was extubated several days later in the ICU with intact baseline mental status and was discharged shortly thereafter to subacute rehab. How likely is it that this patient has LVH? (ie
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