Ischemia Pacemaker STEMI 
Dr. Smith's ECG Blog
MARCH 22, 2024
The fact that R waves 2 through 6 are junctional does make ischemia more difficult to interpret -- but not impossible. Back to the assessment of ischemia: Returning to the ECG, the leads that catch my eye first are -- I, II, V4, V5, V6. For national registry purposes, this will be incorrectly classified as a STEMI.) < 0.049).
Dr. Smith's ECG Blog
JANUARY 1, 2024
Again, see Ken's discussion below) Discussion continued The absence of pace spikes suggests this is not a pacemaker/ICD-related rhythm in this patient with an ICD. Are the apparent P-waves (which now we suspect might not be P-waves) actually part of the QRS, in which case the QRS is even wider than it appears? Where does the QRS begin?
EMS 12-Lead
JUNE 20, 2022
A prehospital STEMI activation was transmitted to the closest PCI center, and 324mg ASA was administered. The attending crews were concerned for an ACS-equivalent of LAD occlusion and initiated a prehospital STEMI activation to the closest PCI center. It’s important to stress the presence of a normal QRS (i.e.,
Dr. Smith's ECG Blog
SEPTEMBER 30, 2019
These findings are concerning for inferior wall ischemia with possible posterior wall involvement. It is also not a wandering pacemaker — because change in atrial pacing site is gradual with that disorder. The morphology in V2 is also concerning and it appears that the ST segment is being pushed down, as in ST depression.
Dr. Smith's ECG Blog
FEBRUARY 15, 2018
100% occluded RCA with TIMI 0 flow Post drug-eluting stent placement with TIMI 3 flow While in the cath lab, she transiently developed complete heart block and became hypotensive requiring transvenous pacemaker placement and transient pressors. The transvenous pacemaker was removed the following day and pressors were not required again.
Dr. Smith's ECG Blog
FEBRUARY 23, 2023
Learning Points: Ectopic atrial rhythm can produce atrial repolarization findings that can be confused for acute ischemia, STEMI, or OMI. See these similar cases: A man in his sixties with chest pain Why is there inferior ST elevation, and would you get posterior leads?
Dr. Smith's ECG Blog
AUGUST 9, 2024
Automatic activity refers to enhanced pacemaking function (typically from a non sinus node source), for example atrial tachycardia. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Is there STEMI? The patient continued having chest pain. What is the rhythm? Moffat, M.
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