Dr. Smith's ECG Blog

OCTOBER 8, 2023

Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. The patient was referred immediately for cath which revealed RCA occlusion that was stented. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia.

Ischemia 123

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 123

Dr. Smith's ECG Blog

MARCH 27, 2025

But it was interpreted as no acute ischemia and the patient was referred to cardiology as Non-STEMI. The total occlusion was recanalized and stented from 100 to 0%. Clinical: patient alerts for refractory ischemia (refractory chest pain), and empowering nurses to advocate for patients 4.

STEMI 80

STEMI Chest Pain Pericarditis Ischemia 80

EMS 12-Lead

MAY 20, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review and commentary by Dr. Steve Smith [link] @SmithECGblog It is early-summer, approximately 1330 hours, no cloud cover overhead, and 86 degrees with high humidity. There is LBBB-like morphology with persistent patterns of subendocardial ischemia.

Cardiomyopathy 52

Cardiomyopathy Ischemia STEMI Coronary Angiogram 52

EMS 12-Lead

AUGUST 14, 2022

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic @DidlakeDW A 50 y/o Male was taking his dog for a leisurely stroll through the park when he suddenly experienced new onset chest discomfort. One stent was deployed with restorative TIMI-0 flow. However, when the Troponin I returned 8.4

STEMI 52

STEMI Sudden Cardiac Death Thrombosis Thrombolysis 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4. An open 90% LAD was stented. He had been awakened by cough at 3 AM 2 days earlier.

STEMI 52

STEMI Chest Pain Myocardial Infarction Angioplasty 52

EMS 12-Lead

JUNE 20, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith @SmithECGblog I was conducting QA/QI on two very recent cases and was struck by the uniqueness of both. He was rushed to the Cath Lab where an LAD culprit lesion was stented. Here is the LAD after stent placement.

STEMI 52

STEMI Stents Stent Myocardial Infarction 52

EMS 12-Lead

APRIL 2, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Expert commentary provided by Dr. Ken Grauer CASE 1 An 82 y/o Male called 911 for sudden onset dizziness while at rest. A 99% LAD occlusion was stented. Upon arrival he was found alert and oriented, and without gross distress. Attached is the first ECG.

Myocardial Infarction 52

Myocardial Infarction Stents Stent STEMI 52