Remove ICU Remove Myocardial Infarction Remove STEMI
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How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Dr. Smith's ECG Blog

Subtle as a STEMI." (i.e., A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. In our study, there were 20/53 complete LAD OMI (TIMI-0 flow) which did not meet STEMI criteria. None of the 20 ever evolved to STEMI criteria. This one is easy for the Queen. Ann Emerg Med [Internet].

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Four anterior STEMIs: acute and reperfused vs. won't reperfuse, subacute and reperfused vs. not reperfused

Dr. Smith's ECG Blog

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. Zwolle Myocardial Infarction Study Group.

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Over-diagnosing MI is not* as negligent as missing it!

Dr. S. Venkatesan MD

and ICU-related anxiety stand apart in this scientific comical game of ruling out a cardiac emergency. What we can do, at our level is to incorporate a new term “ benign or micro myocardial Infarction” – akin to lacunar infarcts or TIA equivalents of the brain in the heart. Reference 1.McCarthy

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OMI Can be Diagnosed by "Pseudonormalization of ST Segments"

Dr. Smith's ECG Blog

Pseudonormalization of STE and/or STD , as in this patient with LVH, but also in LBBB and other etiologies of chronic ST shift, should raise concern for OMI (Occlusion Myocardial Infarction). I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days.

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A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. Association between opioid analgesia and delays to cardiac catheterization of patients with occlusion Myocardial Infarctions. Unfortunately, they follow their own guidelines only 6% of the time!! Lupu L, et al. mg/dL, K 3.5

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A Patient with Respiratory Failure and a Computer "Normal" ECG

Dr. Smith's ECG Blog

The patient was managed in the ICU and had serial troponins. Cardiac Troponin Changes to Distinguish Type 1 and Type 2 Myocardial Infarction and 180-Day Mortality Risk. It is not yet available, but this is your way to get on the list. link] Case continued This OMI was not seen by the providers. He had no more ECGs recorded.

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Machine-learning based risk prediction of in-hospital outcomes following STEMI: the STEMI-ML score

Frontiers in Cardiovascular Medicine

Final models were chosen to optimise area under the curve (AUC) score while ensuring interpretability.ResultsOverall, 128 (6.9%) patients died in hospital, with 292 (15.7%) patients requiring ICU admission and 373 (20.0%) patients with LVEF < 40%. for ICU admission, and 0.74 for in-hospital mortality, 0.78 for LVEF < 40%.

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